Comment on: Urinary tract infection in hospitalized elderly patients in the United Kingdom: the importance of making an accurate diagnosis in the post broad-spectrum antibiotic era

Abstract

Sir, The paper by Gopal Rao and Patel 1 is an important addition to the best management of urinary tract infections (UTIs) in hospitalized elderly patients, and the authors should be congratulated for highlighting the importance of a more focused antibiotic approach. As a practicing clinician, however, I believe that their paper does not emphasize sufficiently what to do in the presence of microbiologically positive urine without accompanying clinical features (asymptomatic bacteriuria), a condition whose prevalence increases with advancing age in both sexes, up to 40% and 50%, respectively, among asymptomatic institutionalized elderly men and women. 2 While it is a fact that the cardinal features of a UTI (fever, abdominal and/or back pain, frequent and painful urination) may sometimes be difficult to elicit in older people, bacteriuria is too often invoked as a spurious explanation for many non-specific symptoms in this population. 3