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Hospital Report: Nearly Half of Older Women Diagnosed With UTIs Do Not Have Findings Confirmed in Urine Culture

Patients receive unnecessary antibiotics (Apr. 22)

Older adults represent an important and growing demographic in emergency departments (EDs) across the country, with urinary tract infections (UTIs) being one of the leading causes for ED visits. UTIs, which can progress to serious health concerns, are the fourth most common diagnosis in women over the age of 65. A new study, conducted at Rhode Island Hospital, has found that many such women receive treatment for a UTI but have no firm evidence of such an infection, resulting in the prescribing of unnecessary antibiotics.

The study was published online in the Journal of the American Geriatrics Society.

Leonard Mermel, DO, and his colleagues found that the collection of urine to rule in or rule out a UTI in this patient population is best done by inserting a temporary catheter into the bladder to collect the specimen rather than by collecting urine by the so-called “clean catch” method. The researchers found that the latter approach more often leads to contamination of the urine specimen.

“Our study had two important findings: elderly women presenting to emergency departments are often presumed to have a UTI and are treated as such, despite a lack of supportive evidence, and that collecting urine by the so-called ‘clean catch’ method more often leads to contamination of the urine specimen,” Mermel said.

Often, a clinician in an ED will base a UTI diagnosis mostly on the patient’s symptoms, particularly in older women for whom UTIs are common. While the patient will have completed a urinalysis, often by clean catch, the results are typically not available during the patient’s visit to the ED. Therefore, the clinician will often prescribe antibiotics to treat the UTI, despite the fact that the diagnosis is not definitive.

The researchers reviewed the medical records of 153 older women who were diagnosed with a UTI during an ED visit. They found that only 57% of the women had urine cultures that confirmed the diagnosis. Of the remaining women, 95% were given or prescribed antibiotics in the ED.

“Ultimately, we found that a large proportion of older women were over-diagnosed and over-treated for UTI,” Mermel said. “Physicians assessing such patients cannot rely on nonspecific symptoms, such as confusion, to confirm a diagnosis of UTI. More widespread use of straight catheterization in this patient population may reduce false-positive results of urine studies, thereby reducing unnecessary antibiotic exposure, and may prompt clinicians to assess these patients for other etiologies to explain their symptoms.”

Source: Rhode Island Hospital; April 22, 2013.

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