From the Guidelines
The primary symptoms to look for in a 90-year-old female with dementia in a long-term care facility (LTCF) suspected of having a urinary tract infection (UTI) include fever, dysuria, gross hematuria, new or worsening urinary incontinence, and/or suspected bacteremia, as well as atypical symptoms such as increased confusion, incontinence, anorexia, or functional decline. When assessing for UTI symptoms in this population, it's crucial to consider that typical urinary symptoms may be absent or presented atypically due to the patient's dementia and age 1. The diagnostic approach should be guided by the presence of acute onset UTI-associated symptoms and signs.
Key Considerations for Diagnosis
- Urinalysis and urine cultures should not be performed for asymptomatic residents 1.
- In noncatheterized residents, the diagnostic laboratory evaluation of suspected UTI should be reserved for those with acute onset of UTI-associated symptoms and signs 1.
- For residents with long-term indwelling urethral catheters, evaluation is indicated if there is suspected urosepsis, especially in the context of recent catheter obstruction or change 1.
Management Approach
- Empiric antibiotic therapy should be initiated based on the presence of symptoms suggestive of UTI, with consideration of the patient's renal function and potential for adverse effects 1.
- Monitoring for changes in mental status is crucial, as UTIs in elderly patients with dementia often present with increased confusion rather than typical urinary symptoms.
- Avoid unnecessary catheterization to reduce the risk of infection.
- Ensure adequate hydration unless contraindicated, and consider preventive measures for recurrent UTIs.
Given the most recent and highest quality evidence 1, the approach to managing suspected UTIs in elderly patients with dementia should prioritize careful assessment of symptoms, appropriate antibiotic therapy when necessary, and supportive care to minimize morbidity, mortality, and improve quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
UTI Symptoms in 90-year-old Female with Dementia
- Change in frequency of urination
- Dysuria (painful urination)
- Urgency (sudden need to urinate)
- Presence or absence of vaginal discharge
- Pyuria (presence of pus in the urine) is commonly found in the absence of infection, particularly in older adults with lower urinary tract symptoms such as incontinence 2
- Nitrites are likely more sensitive and specific than other dipstick components for urinary tract infection, particularly in the elderly 2
Recommended Management for Suspected UTI
- Urine culture is the gold standard for detection of urinary tract infection 2, 3
- First-line treatments for urinary tract infection include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%) 2, 3
- Nitrofurantoin is recommended as a first-line antibiotic for the treatment of urinary tract infections (UTIs), but it is contraindicated in patients with a creatinine clearance (Clcr) less than 60 mL/min 4, 5
- In patients with a high probability of urinary tract infection based on symptoms, negative dipstick urinalysis does not rule out urinary tract infection 2
- Immediate antimicrobial therapy is recommended rather than delayed treatment or symptom management with ibuprofen alone 3
Considerations for Older Adults with Dementia
- UTIs may present differently in older women, and symptoms may be non-specific 2
- Asymptomatic bacteriuria is common in older women and should not be treated with antibiotics 2
- Resistance is increasing to fluoroquinolones, beta-lactams, and trimethoprim-sulfamethoxazole, making it important to choose the optimum empirical regimen based on individualized assessment of risk factors for resistance and regimen tolerability 4, 3