Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
Division of Geriatric Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
PLoS One. 2024 Jun 7;19(6):e0300564. doi: 10.1371/journal.pone.0300564. eCollection 2024.
Urinary tract infections (UTIs) are one of the most common infections reported in older adults, across all settings. Although a diagnosis of a UTI requires specific clinical and microbiological criteria, many older adults are diagnosed with a UTI without meeting the diagnostic criteria, resulting in unnecessary antibiotic treatment and their potential side effects, and a failure to find the true cause of their presentation to hospital.
The aim of this study was to evaluate the accuracy of UTI diagnoses amongst hospitalized older adults based on clinical and microbiological findings, and their corresponding antibiotic treatment (including complications), in addition to identifying possible factors associated with a confirmed UTI diagnosis.
A single-center retrospective cross-sectional study of older adult patients (n = 238) hospitalized at the University of Alberta Hospital with an admission diagnosis of UTI over a one-year period was performed.
44.6% (n = 106) of patients had a diagnosis of UTI which was supported by documents clinical and microbiological findings while 43.3% (n = 103) of patients had bacteriuria without documented symptoms. 54.2% (n = 129) of all patients were treated with antibiotics, despite not having evidence to support a diagnosis of a UTI, with 15.9% (n = 37) of those patients experiencing complications including diarrhea, Clostridioides difficile infection, and thrush. History of major neurocognitive disorder was significantly associated with diagnosis of UTI (p = 0.003).
UTIs are commonly misdiagnosed in hospitalized older adults by healthcare providers, resulting in the majority of such patients receiving unnecessary antibiotics, increasing the risk of complications. These findings will allow for initiatives to educate clinicians on the importance of UTI diagnosis in an older adult population and appropriately prescribing antibiotics to prevent unwanted complications.
尿路感染（UTI）是所有环境中老年人最常见的感染之一。尽管 UTI 的诊断需要特定的临床和微生物学标准，但许多老年人在未达到诊断标准的情况下被诊断为 UTI，导致不必要的抗生素治疗及其潜在的副作用，并且未能找到其住院就诊的真正原因。
本研究旨在评估基于临床和微生物学发现以及相应的抗生素治疗（包括并发症）的住院老年患者 UTI 诊断的准确性，此外还确定与确诊 UTI 诊断相关的可能因素。
对在艾伯塔大学医院住院且在一年期间入院诊断为 UTI 的老年患者（n = 238）进行了一项单中心回顾性横断面研究。
44.6%（n = 106）的患者的 UTI 诊断得到了临床和微生物学发现文件的支持，而 43.3%（n = 103）的患者存在菌尿而无记录症状。尽管没有证据支持 UTI 的诊断，但仍有 54.2%（n = 129）的所有患者接受了抗生素治疗，其中 15.9%（n = 37）的患者出现了并发症，包括腹泻、艰难梭菌感染和鹅口疮。有重大神经认知障碍史的患者与 UTI 诊断显著相关（p = 0.003）。
医疗保健提供者常错误诊断住院老年患者的 UTI，导致大多数此类患者接受不必要的抗生素治疗，增加了并发症的风险。这些发现将为教育临床医生在老年人群中正确诊断 UTI 以及适当开具抗生素以预防不必要的并发症提供依据。
