Can Vicki's urine be checked for signs of infection or sepsis since her urine color changed from clear to dark?

Urinalysis for Suspected Infection in a Long-Term Care Facility Resident

Urinalysis and urine culture should be performed for Vicki only if she is exhibiting specific symptoms of urinary tract infection, such as fever, dysuria, gross hematuria, new or worsening urinary incontinence, or suspected bacteremia. 1

Assessment for Urinary Tract Infection

When to Test

• Urinalysis and urine cultures should NOT be performed for asymptomatic residents, even with a change in urine color 1
• Testing is only indicated in the following scenarios:
  • For non-catheterized residents: Acute onset of UTI-associated symptoms (fever, dysuria, gross hematuria, new/worsening urinary incontinence) 1
  • For residents with indwelling catheters: Suspected urosepsis (fever, shaking chills, hypotension, or delirium) 1

Clinical Evaluation for Suspected Infection

Infection should be suspected in long-term care facility residents with:

• Decline in functional status (new/increasing confusion, incontinence, falling, deteriorating mobility, reduced food intake) 1
• Fever (single oral temperature ≥100°F/37.8°C, repeated oral temperatures ≥99°F/37.2°C, or increase in temperature ≥2°F/1.1°C over baseline) 1

Urine Color Changes

• A change in urine color alone without accompanying symptoms is not an indication for testing 1, 2
• Dark urine can result from:
  • Concentrated urine (dehydration)
  • Medications
  • Foods
  • Normal variations throughout the day

Proper Testing Protocol (If Symptoms Warrant Testing)

If Vicki develops specific UTI symptoms, the following protocol should be followed:

1. Specimen Collection:

   • Obtain an appropriately collected urine specimen:
     • For women: In-and-out catheterization is often required 1
     • For men: Mid-stream or clean-catch specimen, or clean condom external collection system 1
   • If Vicki has an indwelling catheter and urosepsis is suspected, the catheter should be changed prior to specimen collection 1

2. Initial Laboratory Evaluation:

   • Urinalysis for leukocyte esterase and nitrite level by dipstick 1
   • Microscopic examination for WBCs 1
   • Only proceed to urine culture if pyuria is present (≥10 WBCs/high-power field or positive leukocyte esterase or nitrite test) 1

3. Additional Testing if Urosepsis Suspected:

   • Urine and paired blood specimens for culture and antimicrobial susceptibility testing 1
   • Gram stain of uncentrifuged urine 1
   • Complete blood count with differential 1

Avoiding Common Pitfalls

• Overtreatment Risk: Treating asymptomatic bacteriuria or pyuria in elderly patients increases antibiotic resistance without clinical benefit 2
• Misattribution: Non-specific symptoms like confusion or incontinence are often incorrectly attributed to UTI when other causes may be responsible 2
• Specimen Quality: Improper specimen collection can lead to false results; clean-catch midstream specimens or catheterization are preferred 2
• Processing Time: Specimens should be processed within 1 hour at room temperature or within 4 hours if refrigerated 2

Conclusion

Based on the current information provided, a change in urine color alone without specific UTI symptoms does not warrant testing for sepsis or infection. The Infectious Diseases Society of America guidelines clearly state that urinalysis and urine cultures should not be performed for asymptomatic residents 1. Instead, Vicki should be monitored for development of specific UTI symptoms that would indicate the need for testing.