Optimal management of urinary tract infections in older people

Figures & data

Table 1 Definition of terms

Term	Standard definition	Application to management of urinary tract infection (UTI) in elderly patients
Significant bacteriuria	Presence of a specified number (usually >10^5 CFU/mL) of a single species of bacteria in a freshly voided, midstream specimen of urine.	This level of bacteriuria is significant because it is unlikely that it can be explained by contamination of the urine sample with perineal flora. It DOES NOT indicate clinically significant bacteriuria. “Significant” bacteriuria is often asymptomatic and does not necessarily require treatment. Lower levels may sometimes be significant.
Uncomplicated urinary tract infection	Lower urinary tract infection in an adult woman who is not pregnant and has no underlying abnormality of the urinary tract or indwelling urinary device.	The evidence about effectiveness of short (3 day) courses of treatment for UTI only applies to uncomplicated UTIs. All UTIs in males, all UTIs associated with urinary catheters, and all UTIs with systemic symptoms are complicated UTIs.
Lower urinary tract infection	Infection confined to the tissues of the bladder or urethra. The presence of symptoms or signs of systemic infection indicates upper urinary tract infection.	Both nitrofurantoin and fosfomycin only achieve effective concentrations in the lower urinary tract infection. These antibiotics should not be used to treat patients with systemic symptoms or signs.

Figure 1 Negative predictive value (NPV) and positive predictive value (PPV) for dipstick urine testing for diagnosis of bacteriuria in a nursing home population. Test characteristics of a positive leukocyte esterase and/or a positive nitrite dipstick were compared to urine culture. These results were for visual reading of the dipstick; results with analyzer reading were almost identical. Data adapted from Sundvall and Gunnarsson.²⁰

SundvallP-DGunnarssonRKEvaluation of dipstick analysis among elderly residents to detect bacteriuria: a cross-sectional study in 32 nursing homesBMC Geriatr200993219635163

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