Possible UTI in Older people



Background

  • New onset dysuria is one of the best indicators of a UTI.
  • In older patients, urinary studies should only be performed if a patient's urinary symptoms worsen acutely and there is no other identifiable cause.
  • Non-specific symptoms should not be the only reason for obtaining urinary studies.

Criteria for ordering urine MC&S
If fever >37.9°C and 1 or more of the following, order a urine culture:
- Dysuria
- Urgency
- Flank pain
- Rigors
- Urinary incontinence
- Frequency
- Frank haematuria
- Suprapubic pain
or, if no fever, request M,C&S if there is new onset burning on urination, or 2 or more of the following:
- urgency
- Flank pain
- Rigors
- Urinary incontinence
- Frequency, suprapubic pain
- Frank haematuria
Or
If fever >37.9°C but 2 or more symptoms of non-UTI infection, do not order a urine.


Causes of smelly urine

  • Asparagus, garlic, onions, coffee
  • Dehydration
  • Vitamin B6 supplements
  • Incontinence
  • UTI

Urinary incontinence is NEVER normal

Causes incontinence

D - Delirium

I - Infection

A - Atrophic Vaginitis / Urethritis

P - Pharmaceuticals

P - Psychological (rare)

E - Excessive Urine Output

R - Restricted Mobility

S - Stool Impaction

Incontinence drugs

  • Diuretics
  • Anticholinergics
  • Psychotropics:
    • Antidepressants
    • Antipsychotics
    • Sedative hypnotics
  • Narcotic analgesics
  • Ca++ channel blockers
  • Alcohol

Investigations

?UTI - approach in older people
Patient Hx Symptoms Signs Urine dip

Clear and unambiguous

New onset of frequency, dysuria Abdo. pain, Haematuria, Smelly urine, Fever Negative – seek other cause. Do not send MSU

Clear & unambiguous

New onset of frequency, dysuria Abdo. pain, Haematuria, Smelly urine, Fever Positive for leucocytes and nitrites – likely UTI, send MSU and treat

Clear & unambiguous

No urinary symptoms Do not dip urine, do not send MSU

Lacking - communication

↑confusion, apathy, irritability, (delirium), ↓mobility, off food Abdo. pain, Haematuria, Offensive smelling urine, Fever Negative – seek other cause. Do not send MSU

Lacking - communication

↑confusion, apathy, irritability, (delirium), ↓mobility, off food Abdo. pain, Haematuria, Offensive smelling urine, Fever Positive for leucocytes & nitrites – likely UTI - send MSU and treat

Lacking - communication

↑confusion, apathy, irritability, (delirium), ↓mobility, off food Abdo. pain, Haematuria, Offensive smelling urine, Fever Leucocyte positive only – seek alternative diagnosis
Nitrite positive only – send MSU and start treatment


Content By Dr Íomhar O' Sullivan . Last review Dr ÍOS 13/07/21.