Diagnosis of urinary tract infection in older persons in the emergency department: To pee or not to pee, that is the question

Burkett, Ellen; Carpenter, Christopher R.; Arendts, Glenn; Hullick, Carolyn; Paterson, David L.; Caterino, Jeffrey M.

doi:10.1111/1742-6723.13376

Cited by 7 publications

(3 citation statements)

References 48 publications

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“…7,8 It is not surprising that this trend is continuing for urinary symptoms, because we have discovered that many urinary symptoms are not caused by bacterial infection. 2,3,9 Therefore, stopping antibiotics prescribed for urinary symptoms when the UC is negative is a sensible, pragmatic, and important process improvement that should be considered for all EDs. Similar interventions have been successful when relying on nonpharmacy personnel, including advanced practice providers and nurses.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although bacterial urinary tract infection (UTI) is one possible cause of these symptoms, many other conditions present similarly. 2,3 To make the diagnosis in the ED, clinicians use a combination of history, symptoms, and urinalysis (UA). Although urine culture (UC) is the gold standard for diagnosis, it does not typically result for 24-48 hours.…”

Section: Introductionmentioning

confidence: 99%

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An Initiative to Stop Antibiotics Prescribed for Urinary Symptoms When Urine Culture Is Negative

Kofoed,

Morris,

Rich

2023

J Healthc Qual

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Urinary symptoms pose frequent diagnostic and management challenges in the emergency department (ED). In our regional health system, we identified the problem of patients started on antibiotics for urinary symptoms in the ED without a process for eventual review or discontinuation if urine culture (UC) later resulted as negative. To address this gap, we implemented a pharmacist-driven follow-up process to discontinue antibiotics after a negative UC. After project implementation, cases reviewed by a pharmacist increased from 0% to 96.7%. Patients contacted to discontinue antibiotics increased from 0% to 40% postintervention. This process improvement is now shared across five rural departments. Our results have broad applicability in any ED environment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Initiative to Stop Antibiotics Prescribed for Urinary Symptoms When Urine Culture Is Negative

Kofoed,

Morris,

Rich

2023

J Healthc Qual

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“…The presence of acute urinary symptoms and laboratory evidence (such as a positive urine culture) is required to make a formal UTI diagnosis. Difficulties collecting a urine specimen, an inability to accurately report symptoms, together with the high prevalence of asymptomatic bacteriuria in people with dementia, may lead to misdiagnosis, particularly in those whose dementia is severe 30 31. Furthermore, non-specific symptoms such as new onset or worsening of confusion is a common reason suspecting a UTI in elderly patients and may also lead to overdiagnosis in this population 32.…”

Section: Discussionmentioning

confidence: 99%

Potentially avoidable causes of hospitalisation in people with dementia: contemporaneous associations by stage of dementia in a South London clinical cohort

Gungabissoon

Perera

Galwey³

et al. 2022

BMJ Open

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ObjectivesTo estimate the frequency of all-cause and ambulatory care sensitive condition (ACSCs)-related hospitalisations among individuals with dementia. In addition, to investigate differences by stage of dementia based on recorded cognitive function.SettingData from a large London dementia care clinical case register, linked to a national hospitalisation database.ParticipantsIndividuals aged ≥65 years with a confirmed dementia diagnosis with recorded cognitive function.Outcome measuresAcute general hospital admissions were evaluated within 6 months of a randomly selected cognitive function score in patients with a clinical diagnosis of dementia. To evaluate associations between ACSC-related hospital admissions (overall and individual ACSCs) and stage of dementia, an ordinal regression was performed, modelling stage of dementia as the dependant variable (to facilitate efficient model selection, with no implication concerning the direction of causality).ResultsOf the 5294 people with dementia, 2993 (56.5%) had at least one hospitalisation during a 12-month period of evaluation, and 1192 (22.5%) had an ACSC-related admission. Proportions with an all-cause or ACSC-related hospitalisation were greater in the groups with more advanced dementia (all-cause 53.9%, 57.1% and 60.9%, p 0.002; ACSC-related 19.5%, 24.0% and 25.3%, p<0.0001 in the mild, moderate and severe groups, respectively). An ACSC-related admission was associated with 1.3-fold (95% CI 1.1 to 1.5) increased odds of more severe dementia after adjusting for demographic factors. Concerning admissions for individual ACSCs, the most common ACSC was urinary tract infection /pyelonephritis (9.8% of hospitalised patients) followed by pneumonia (7.1%); in an adjusted model, these were each associated with 1.4-fold increased odds of more severe dementia (95% CI 1.2 to 1.7 and 1.1 to 1.7, respectively).ConclusionsPotentially avoidable hospitalisations were common in people with dementia, particularly in those with greater cognitive impairment. Our results call for greater attention to the extent of cognitive status impairment, and not just dementia diagnosis, when evaluating measures to reduce the risk of potentially avoidable hospitalisations.

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Urinary Tract Infection

Sanderman¹,

Raja²

2023

Evidence‐Based Emergency Care

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Diagnosis of urinary tract infection in older persons in the emergency department: To pee or not to pee, that is the question

Cited by 7 publications

References 48 publications

An Initiative to Stop Antibiotics Prescribed for Urinary Symptoms When Urine Culture Is Negative

An Initiative to Stop Antibiotics Prescribed for Urinary Symptoms When Urine Culture Is Negative

Potentially avoidable causes of hospitalisation in people with dementia: contemporaneous associations by stage of dementia in a South London clinical cohort

Urinary Tract Infection

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