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UTIs in Older People Dr Rohan Wee Aged Care Physician Northern Health.

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Presentation on theme: "UTIs in Older People Dr Rohan Wee Aged Care Physician Northern Health."— Presentation transcript:

1 UTIs in Older People Dr Rohan Wee Aged Care Physician Northern Health

2 Are UTIs Important?  Most frequent infection in residential care  Dementia, incontinence & decreased mobility are risk factors for developing UTIs  Asymptomatic bacteriuria is common –15-30% in men –25-50% in women  Long term IDCs are always colonised

3 How do we diagnose a UTI?  Symptoms –Dysuria, frequency, lower abdominal pain, urgency, haematuria –Absence of vaginal discharge or irritation  Probability of UTI in women 90%  Urinalysis –Pyuria  MSU

4 The problem is…  Residential care residents often can’t give reliable histories  Urinalysis and culture are often done for atypical symptoms –Change in behaviour –Decrease in appetite etc  Asymptomatic bacteriuria is common

5 Asymptomatic bacteriuria (1)  Is more common in –Diabetics –The elderly –Long term IDCs  Pyuria is not a reliable predictor of bacteriuria –Urinalysis is not useful in predicting bacteriuria

6 Asymptomatic bacteriuria (2)  Why would we treat if asymptomatic? –Prevent later infections  Not evidence to suggest this works  Less asymptomatic bacteriuria in follow up but not UTIs –Survival benefit  Increased mortality in patients with bacteriuria  No improvement in mortality if treated  Probably reflects differences in patient groups –Improve continence  No benefit in a residential care population

7 What to do …  When the urine smells or is cloudy  When the FWT is “positive”  With the MSU results

8 “Doctor - the urine smells”  No evidence that an offensive odour correlates with UTI –Prospective trial comparing diagnosis by smell to clean catch urine did not find that smell was reliable in identifying UTI  No evidence that cloudy urine correlates to UTI

9 Urinalysis in Residential Care  Does a “positive” FWT mean UTI? –High false positive rate –False negatives do occur  In an asymptomatic patient –Positive FWT is probably a false positive –Negative FWT means UTI unlikely

10 The MSU is Positive  The asymptomatic patient  The symptomatic patient  Long term IDC

11 The Asymptomatic patient  A positive MSU probably represents asymptomatic bacteriuria  No treatment is required  Observe patient

12 The Symptomatic patient  Treat with appropriate antibiotics

13 Long Term IDC  Always colonised  MSU/CSU –May indicate what bacteria to treat if the patient becomes unwell  Ideally change IDC just before CSU for most accurate results  Treat if symptomatic –Fever, loin pain

14 Non-specific Decline (1)  The evidence for the correct course of action is poor  Assess the patient –History –Examination –Investigations  FBE, U&E, +/- CXR  FWT/MSU

15 Non-specific Decline (2)  FWT –Positive may be a false positive –Negative makes UTI less likely  MSU –Will guide antibiotic choice if LMO chooses to treat  May be treating asymptomatic bacteriuria  Treating a “UTI” should occur after other causes have been excluded if the situation requires it

16 Preventing Recurrent UTI (1)  Increased fluid intake –No evidence but it may be helpful  Cranberry juice –Some limited evidence –Limitations  Variable dose and duration  Calorie load  Not clear if cranberry tablets are of benefit

17 Preventing Recurrent UTI (2)  Topical oestrogen –Improves atrophic vaginitis –Encourages lactobacilli growth, decreases E. coli growth  Antibiotic prophylaxis –Useful if >3 symptomatic UTIs/year –Risk of resistant organisms

18 References  Up To Date –Recurrent UTI in women –Overview of acute cystitis in women –Approach to the patient with asymptomatic bacteriuria –UTI associated with indwelling catheter  UTI in geriatric and institutionalized patients L. E. Nicholle, Current Opinion in Urology 2002, 12:51-55

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