Urinary Tract Infections in older adults Flashcards
1
Q
Diagnosis
A
Should have at least 3 acute urinary symtoms
- dysuria
- frequency
- suprapubic tenderness
- urgency
- polyuria
- haemature
If unable to obtain a history, diagnose if evidence of acute inflammatory response:
- Fever/hypothermia
- elevated WCC or CRP
- SIRS
- Positive urine culture
2
Q
SIRS
A
- HR >90 bpm
- RR >20 breaths/per minute
- WCC >12 or <4
- Temp - >38 or <36
- blood glucose >7.7 in the absence of diabetes
- acutely altered mental state
3
Q
Asymptomatic bacteruria
A
- Presence of bacteria in the urine without typical symptoms or signs of urinary tract infection
- Counts of greater than 105 colony forming units per millilitre of urine (cfu/mL) are diagnostic of asymptomatic bacteriuria if present in a single sample in men or on two consecutive occasions in women
- This is common in older people (up to 50% in older women living in long term care) and when occurs alone is NOT an indication for treatment. Treatment of asymptomatic bacteruria causes more harm than benefit in older adults.
4
Q
Urine Culture
A
Consider in 2 situations
1) Acute urinary symptoms typical of a urinary tract infection, to confirm susceptibility to empirical antibiotic treatment
2) Patients who are unable to provide a history of acute urinary symptoms but have features of systemic inflammation and no other more likely source of infection or explanation for their acute illness.
