What are the signs of Urinary Tract Infection (UTI) in elderly male patients with Dementia in long-term care?

From the Guidelines

Elderly male patients with dementia in long-term care typically present with atypical symptoms of Urinary Tract Infection (UTI), such as altered mental status, functional decline, fatigue, or falls.

Signs of UTI in this population may include:

• New onset of confusion or delirium 1
• Fever 1
• Dysuria 1
• Gross hematuria 1
• New or worsening urinary incontinence 1
• Functional decline 1
• Fatigue 1
• Falls 1

Diagnostic approach:

• Urinalysis and urine cultures should not be performed for asymptomatic residents 1
• Diagnostic laboratory evaluation of suspected UTI should be reserved for those with acute onset of UTI-associated symptoms and signs 1
• Minimum laboratory evaluation for suspected UTI should include urinalysis for determination of leukocyte esterase and nitrite level by use of a dipstick and a microscopic examination for WBCs 1
• If pyuria is present, a urine culture (with antimicrobial susceptibility testing) should be ordered 1

From the Research

Signs of Urinary Tract Infection (UTI) in Elderly Male Patients with Dementia

• The signs of UTI in elderly male patients with dementia can be challenging to diagnose due to the presence of cognitive impairment and other comorbidities 2, 3
• Common signs of UTI in this population include:
  • Mental status change (44.3%) 3
  • Fever (20.6%) 3
  • Hematuria (6.9%) 3
  • Dysuria (3.8%) 3
  • Costovertebral tenderness (2.3%) 3
  • Urinary frequency (1.5%) 3
  • Rigor (1.5%) 3
• However, these symptoms may not always be present, and the diagnosis of UTI can be complicated by the presence of asymptomatic bacteriuria 4, 5, 6
• The use of multireagent strips to diagnose UTI in this population has been shown to have limited accuracy, with high false-negative rates 4
• Urine culture results are often positive in patients with suspected UTI, regardless of symptoms 3

Diagnosis and Management of UTI

• The diagnosis of UTI in elderly male patients with dementia requires a comprehensive approach, taking into account the patient's medical history, physical examination, and laboratory results 2, 5, 6
• The management of UTI in this population should be guided by evidence-based guidelines, with a focus on treating symptomatic infections and avoiding overtreatment of asymptomatic bacteriuria 5, 6
• Antimicrobial therapy should be prescribed judiciously, with consideration of the potential risks and benefits, including the development of antibiotic-resistant organisms 4, 6