How to manage mood changes in a patient after a urinary tract infection (UTI)?

Managing Mood Changes in Patients After UTI

For patients experiencing mood changes after a urinary tract infection (UTI), assessment for other causes and careful observation rather than antimicrobial treatment is strongly recommended, unless there are focal genitourinary symptoms or systemic signs of infection.

Distinguishing Between UTI-Related and Non-UTI-Related Mood Changes

• Mental status changes after UTI are often incorrectly attributed to persistent infection when they may be due to other causes 1
• Observational evidence suggests that while patients with delirium are more likely to have bacteriuria than patients without delirium, a causal relationship between bacteriuria and delirium has not been established 1
• Mood changes without focal genitourinary symptoms (frequency, urgency, dysuria) should prompt evaluation for other causes rather than assuming ongoing UTI 1

Diagnostic Approach for Mood Changes After UTI

• Evaluate for common precipitating factors of altered mental status including:

  • Electrolyte disorders, dehydration, and medication side effects 2
  • Constipation (often overlooked cause of altered mental status) 2
  • Other infections beyond the urinary tract 2

• Laboratory workup should include:

  • Complete metabolic panel to assess electrolytes and renal function 2
  • Complete blood count to identify potential underlying infection 2
  • Consider brain imaging if symptoms are severe, progressive, or accompanied by focal neurological signs 2

Management Algorithm

1. Determine if focal genitourinary symptoms are present:

   • If dysuria, frequency, urgency, or costovertebral angle tenderness are present → consider treating for UTI 1
   • If these symptoms are absent → do not treat with antibiotics for UTI 1

2. Assess for systemic signs of infection:

   • Fever (oral temperature >37.8°C or 1.1°C increase over baseline) 1
   • Rigors/shaking chills 1
   • Clear-cut delirium (not just mood changes) 1
   • If present without other localizing source → consider broad-spectrum antimicrobial therapy 1

3. For mood changes without focal symptoms or systemic signs:

   • Implement careful observation and monitoring 1
   • Evaluate for other contributing factors 1, 2
   • Avoid unnecessary antimicrobial treatment 1

Evidence on Treatment Outcomes

• Studies show that antimicrobial treatment of asymptomatic bacteriuria in patients with mental status changes does not improve outcomes 1
• One study found that delirious patients treated for asymptomatic bacteriuria had poorer functional outcomes compared to untreated patients (adjusted OR, 3.45 [95% CI, 1.27–9.38]) 1
• Delirious patients treated for asymptomatic bacteriuria were more likely to develop Clostridioides difficile infection than untreated patients (OR, 2.45 [95% CI, .86–6.96]) 1

Psychological Aspects of Post-UTI Mood Changes

• Social function and psychological well-being can be significantly affected by UTIs, with mental role functioning showing substantial reduction 3
• Psychological distress and neuroticism have been identified as predictors of long-term urinary tract complaints, but not of bacteriuria, suggesting different etiologies 4, 5
• Identification and treatment of psychological distress should be part of follow-up care for patients with mood changes after UTI 4

Important Caveats and Pitfalls

• Avoid attributing all mental status changes to UTI without thorough evaluation for other causes 1, 2
• Be cautious with antimicrobial treatment for asymptomatic bacteriuria as it may lead to adverse outcomes including Clostridioides difficile infection and increased antimicrobial resistance 1
• Remember that delirium has a fluctuating course; careful observation and evaluation for contributing factors is essential 1
• For older patients with severe presentations consistent with sepsis and no other apparent infection source, empiric antimicrobial therapy may be appropriate pending culture results 1