The Dilemma of Suspected Urinary Tract Infections in Older Women

In an observational study, many women treated for UTIs subsequently had negative cultures.

In ambulatory care settings, older women frequently are diagnosed with urinary tract infections (UTIs) on the basis of nonspecific symptoms (e.g., mental status changes, malaise) and abnormal urinalysis. Because urine culture results aren't available for several days, many patients whose cultures ultimately are negative receive antibiotics.

In this retrospective study from an emergency department in Rhode Island, researchers identified 153 women (age, 70; mean age, 83) who received UTI diagnoses and for whom urine cultures were ordered. Urine was obtained by clean catch in 58% and by catheterization in 42%. Urinary symptoms were the chief complaint in only 18%; other complaints included altered mental status (18%), abdominal or back pain (16%), and falling (13%). In nearly all cases, urine "dipsticks" were positive for either nitrite or leukocyte esterase.

Almost all patients received antibiotics, but only 57% ultimately had positive urine cultures. Neither the presence of urinary symptoms nor a urinalysis finding of 10 white blood cells per high-power field predicted urine culture positivity.

CITATION(S):

Gordon LB et al. Overtreatment of presumed urinary tract infection in older women presenting to the emergency department. J Am Geriatr Soc 2013 May; 61:788.