- Title
- Diagnosis of urinary tract infection in older persons in the emergency department: to pee or not to pee, that is the question
- Creator
- Burkett, Ellen; Carpenter, Christopher R.; Arendts, Glenn; Hullick, Carolyn; Paterson, David L.; Caterino, Jeffrey M.
- Relation
- Emergency Medicine Australasia Vol. 31, Issue 5, p. 856-862
- Publisher Link
- http://dx.doi.org/10.1111/1742-6723.13376
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2019
- Description
- Accurate diagnosis of UTI in older persons is hindered by high rates of asymptomatic bacteriuria (ASB); lack of a definitive test to support accurate timely diagnosis; and comorbidities, such as immunosuppression and cognitive impairment, which impede assessment for symptoms and signs of UTI. Both under-diagnosis and overdiagnosis is common, but overdiagnosis seems the more pressing problem in geriatric emergency medicine and is the focus of this article. A retrospective study of emergency admissions of those aged 75+ years treated with intravenous antibiotics for a UTI found that 43% did not meet defined criteria for that diagnosis. Myriad problems then result: 8% of those treated developed Clostridium difficile diarrhoea; emerging evidence shows the urinary microbiome helps to prevent overgrowth of pathogenic bacteria, so inappropriate antibiotics actually promote UTI; and multi-resistant antimicrobial resistance is promoted. Multiple studies show that antibiotics do not provide any benefit in older persons with ASB, and in fact expose them to risks of allergies, multi-resistant organisms and Clostridium difficile infection.
- Subject
- urinary tract infection (UTI); elderly; antibiotic; assessment
- Identifier
- http://hdl.handle.net/1959.13/1488650
- Identifier
- uon:52497
- Identifier
- ISSN:1742-6731
- Language
- eng
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