Rutten Jeanine J S, Hartman Esther A R, vanHorrik Tessa M Z X K, vanBuul Laura W, Geerlings Suzanne E, Hertogh Cees M P M
Amsterdam UMC, locatie VUmc, afd. Ouderengeneeskunde.
Contact: Jeanine J.S. Rutten (
Ned Tijdschr Geneeskd. 2022 Dec 22;166:D7034.
In frail older adults, antibiotics are often inappropriately prescribed for suspected urinary tract infections (UTIs). We describe three cases in the general practice, nursing home, and emergency department setting to illustrate how to improve diagnosing UTIs in frail older patients. Nonspecific symptoms, e.g., behavioral change or smelly urine, often trigger a UTI suspicion followed by immediate urine testing and antibiotic treatment. However, nonspecific symptoms should trigger a broad differential diagnosis and thorough evaluation. The value of urine tests is limited due to the high prevalence of asymptomatic bacteriuria in this patient group; a UTI is thus a clinical diagnosis not solely based on a positive urine test. Antibiotic treatment is recommended only in case of symptoms referable to the urinary tract or systemic symptoms in patients without a urinary catheter. In patients with a urinary catheter, antibiotic treatment is recommended in case of systemic symptoms without any other focus.
在体弱的老年人中，抗生素常常被不恰当地用于治疗疑似尿路感染（UTI）。我们描述了三例分别发生在全科医疗、养老院和急诊科的病例，以说明如何改善对体弱老年患者尿路感染的诊断。非特异性症状，如行为改变或尿液有异味，常常引发对尿路感染的怀疑，随后立即进行尿液检测和抗生素治疗。然而，非特异性症状应引发广泛的鉴别诊断和全面评估。由于该患者群体中无症状菌尿的高发生率，尿液检测的价值有限；因此，尿路感染是一种临床诊断，不能仅基于尿液检测呈阳性。仅在无导尿管的患者出现泌尿系统相关症状或全身症状时，才建议使用抗生素治疗。对于有导尿管的患者，在出现全身症状且无其他感染灶时，建议使用抗生素治疗。
