From the Guidelines
Delusions associated with urinary tract infections (UTIs) will likely resolve once the infection is properly treated, but the most recent and highest quality study suggests that treating asymptomatic bacteriuria (ASB) with antibiotics may not improve outcomes in patients with delirium 1. The standard treatment for UTIs includes antibiotics such as nitrofurantoin (Macrobid), trimethoprim-sulfamethoxazole (Bactrim), or ciprofloxacin, usually taken for 3-7 days depending on the severity of the infection. In elderly patients especially, UTIs can cause confusion, hallucinations, or delusions due to the inflammatory response affecting brain function. This condition, sometimes called "UTI-induced delirium," generally clears up within days of starting appropriate antibiotic therapy and ensuring proper hydration. However, complete resolution may take up to two weeks in some cases, particularly in older adults. Some key points to consider when managing UTIs in older adults include:
- Evaluating for other contributing factors, such as dehydration, and addressing these issues to reduce unnecessary antimicrobial use for bacteriuria 1.
- Considering the potential risks and benefits of antibiotic treatment, including the risk of antimicrobial resistance and Clostridioides difficile infection (CDI) 1.
- Using a holistic assessment approach to diagnose UTIs, including nonspecific symptoms such as confusion or functional decline 1.
- Prioritizing antimicrobial stewardship to combat the rising threat of antimicrobial resistance 1. If delusions persist after the UTI has been successfully treated, it's essential to seek medical attention as this could indicate another underlying condition. During treatment, maintaining good hydration by drinking plenty of water helps flush bacteria from the urinary system and speeds recovery. It's also crucial to carefully consider comorbidities, polypharmacy, and the risk of potential adverse events when managing UTIs in older adults 1.
From the Research
UTI Delusions
- UTI delusions, also known as antibiotic-associated psychosis, have been reported in patients treated with antibiotics for urinary tract infections 2.
- The primary findings of a systematic review of cases of antibiotic-associated acute psychosis during treatment of a UTI suggest that acute psychosis is a potential adverse effect of antibiotic treatment of UTI, although the mechanism(s) underlying this association remains unclear 2.
- The onset and resolution of psychosis often occur within 1 week of initiation and discontinuation of the antibiotic, respectively 2.
Resolution of UTI Delusions
- Approximately half of the cases of antibiotic-associated psychosis do not require treatment with antipsychotics, and the delusions often resolve on their own after discontinuation of the antibiotic 2.
- The resolution of UTI delusions is often associated with the resolution of the UTI itself, highlighting the importance of proper treatment and management of the underlying infection 3, 4.
Factors Associated with UTI Delusions
- Confusion is a significant factor associated with antibiotic treatment for suspected UTI, and is often one of the strongest factors associated with UTI delusions 5.
- Other factors associated with UTI delusions include urinary catheter, urinary frequency, fever, and new-onset hypotension 5.
- The presence of these factors can increase the risk of developing UTI delusions, and highlights the importance of careful monitoring and management of patients with UTIs 4, 5.