How to manage delirium in a patient with Urinary Tract Infection (UTI)?

From the Guidelines

To help someone with a UTI who is experiencing delirium or confusion, first seek immediate medical attention as this indicates a potentially serious infection that may have spread beyond the urinary tract. While waiting for medical help, ensure the person stays hydrated, help them take any previously prescribed antibiotics exactly as directed, keep track of their symptoms, and create a calm, familiar environment by speaking clearly, providing reassurance, and removing potential sources of agitation. Delirium associated with UTIs occurs because bacteria from the infection can release toxins into the bloodstream, and in older adults or those with weakened immune systems, these toxins can cross the blood-brain barrier and temporarily affect brain function. The confusion typically resolves once the underlying infection is treated with appropriate antibiotics, which might include nitrofurantoin, trimethoprim-sulfamethoxazole, or ciprofloxacin for 3-7 days depending on the severity and the specific bacteria involved. If the person appears severely confused, has a high fever, or shows signs of sepsis (rapid breathing, extreme fatigue, low blood pressure), call emergency services immediately as this could be life-threatening.

Some key considerations in managing delirium include:

• Addressing cognitive impairment or disorientation by providing appropriate lighting and clear signage, ensuring that a clock and a calendar are easily visible to the person at risk 1
• Ensuring adequate fluid intake to prevent dehydration and constipation 1
• Assessing for hypoxia and optimizing oxygen saturation if necessary 1
• Addressing infection by looking for and treating infection, avoiding unnecessary catheterization, and implementing infection-control procedures 1
• Addressing immobility or limited mobility through encouraging persons to mobilize soon after surgery and walk, and encouraging all persons to carry out active, range-of-motion exercises 1

It is essential to note that the management of delirium should be tailored to the individual's needs and care setting, and a multidisciplinary team trained and competent in delirium prevention should deliver the intervention 1. In older patients with functional and/or cognitive impairment with bacteriuria and delirium, assessment for other causes and careful observation rather than antimicrobial treatment may be recommended 1.

However, the most recent and highest quality study 1 suggests that in older patients with functional and/or cognitive impairment with bacteriuria and delirium, careful observation rather than antimicrobial treatment may be recommended, emphasizing the importance of assessing for other causes of delirium.

Given the potential severity of UTI-associated delirium, immediate medical attention is crucial, and treatment should be guided by the most recent and highest quality evidence available 1.

From the Research

Helping Someone with UTI Come Out of Delusion

To help someone with a urinary tract infection (UTI) come out of delusion, it is essential to understand the potential relationship between UTIs and neuropsychiatric disorders.

• UTIs have been associated with acute psychosis, delirium, dementia, psychotic disorders, and mood disorders 2, 3, 4.
• The treatment of UTI with certain antibiotics, such as trimethoprim-sulfamethoxazole, may contribute to the development of psychosis or delusions 2, 3.
• Discontinuation of the offending antibiotic may lead to a marked improvement in symptoms, as seen in a case report where a patient's delusions resolved 60 hours after discontinuing trimethoprim-sulfamethoxazole therapy 3.

Management of UTI-Associated Delusions

• The primary approach to managing UTI-associated delusions is to treat the underlying infection with an appropriate antibiotic, while monitoring for any potential adverse effects on mental status 5, 6.
• In some cases, the delusions may resolve on their own after the UTI is treated, without the need for additional psychiatric intervention 4.
• However, if the delusions persist or are severe, consultation with a psychiatrist or other mental health professional may be necessary to determine the best course of treatment.

Key Considerations

• It is crucial to recognize that UTIs can have a significant impact on mental health, particularly in hospitalized patients or those with pre-existing neuropsychiatric disorders 4.
• A comprehensive approach to managing UTIs should include consideration of the potential effects on mental status, as well as the physical symptoms of the infection 6, 4.