Abstract
Objectives
Nonspecific signs and symptoms combined with positive urinalysis results frequently
trigger antibiotic therapy in frail older adults. However, there is limited evidence
about which signs and symptoms indicate urinary tract infection (UTI) in this population.
We aimed to find consensus among an international expert panel on which signs and
symptoms, commonly attributed to UTI, should and should not lead to antibiotic prescribing
in frail older adults, and to integrate these findings into a decision tool for the
empiric treatment of suspected UTI in this population.
Design
A Delphi consensus procedure.
Setting and Participants
An international panel of practitioners recognized as experts in the field of UTI
in frail older patients.
Measures
In 4 questionnaire rounds, the panel (1) evaluated the likelihood that individual
signs and symptoms are caused by UTI, (2) indicated whether they would prescribe antibiotics
empirically for combinations of signs and symptoms, and (3) provided feedback on a
draft decision tool.
Results
Experts agreed that the majority of nonspecific signs and symptoms should be evaluated
for other causes instead of being attributed to UTI and that urinalysis should not
influence treatment decisions unless both nitrite and leukocyte esterase are negative.
These and other findings were incorporated into a decision tool for the empiric treatment
for suspected UTI in frail older adults with and without an indwelling urinary catheter.
Conclusions
A decision tool for suspected UTI in frail older adults was developed based on consensus
among an international expert panel. Studies are needed to evaluate whether this decision
tool is effective in reaching its aim: the improvement of diagnostic evaluation and
treatment for suspected UTI in frail older adults.
Keywords
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Article info
Publication history
Published online: June 14, 2018
Footnotes
This work was supported by the Dutch Ministry of Health, Welfare and Sport, by providing a grant to the Dutch Association of Elderly Care Physicians (Verenso).
L.B. reports personal fees from the Dutch Association of Elderly Care Physicians, during the conduct of the study; H.V. reports grants from the Dutch Ministry of Health, Welfare and Sport, during the conduct of the study; S.G.s reports personal fees from InfectoPharm, outside the submitted work; D.N. reports grants from the Agency for Healthcare Research and Quality and grants from the National Institute of Aging, during the conduct of the study; P.U. reports personal fees from the Swedish Medical Products Agency, outside the submitted work; the other authors have no competing interests to disclose.
Identification
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
