Diagnosis and management of urinary tract infection in hospitalized older people.

Abstract:

OBJECTIVES:To compare the diagnosis and management of urinary tract infection (UTI) in hospitalized older people with clinical criteria and therapeutic guidelines. DESIGN:A retrospective case series of emergency hospital admissions collected over an 18-month period. SETTING:An acute general hospital in northwest England. PARTICIPANTS:Two hundred sixty-five patients aged 75 and older with a diagnosis of UTI at hospital discharge. MEASUREMENTS:Data relating to age, sex, presenting complaint, admission and discharge destinations, background comorbidities and medications, investigations performed, treatment given, length of stay, and complications were obtained using chart review. RESULTS:Of the 265 patients (mean age 85.4) the overdiagnosis of UTI was common, with 43.4% of patients not meeting criteria. Only 32.1% of patients overall had any urinary tract symptoms (48.7% in the UTI group). Of the non-UTI group, 12 (10.4%) had urinary tract symptoms with a negative urine culture, 43 (37.4%) had asymptomatic bacteriuria (ASB), and 60 (52.2%) had neither urinary tract symptoms nor bacteriuria. Treatment given varied greatly. The mortality rate was 6.0%, and the average length of stay was 29.9 days (median 17.0, range 1-192). Complications were frequent, including Clostridium difficile diarrhea (8%), falls (4%), methicillin-resistant Staphylococcus aureus infection (3%), and fracture (2%). CONCLUSION:More-reliable criteria are needed to aid the diagnosis of UTI in hospitalized older people. Better adherence to clinical management guidelines may improve outcomes.

journal_name

J Am Geriatr Soc

authors

Woodford HJ,George J

doi

10.1111/j.1532-5415.2008.02073.x

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

107-14

issue

1

eissn

0002-8614

issn

1532-5415

pii

JGS2073

journal_volume

57

pub_type

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