Difficulties in diagnosis and treatment of urinary tract infections in an elderly population

Abstract

Background Urinary tract infection (UTI) contributes significantly to healthcare burden, accounting for 23 % of hospital acquired infections and 2–3 % of general practice consultations. Unfortunately, difficulties exist in obtaining an accurate diagnosis, with studies showing misdiagnosis rates above 40 % in elderly populations. Furthermore, numerous hospitals across the UK still advocate the use of Trimethoprim for UTI, despite high rates of resistance. These factors combined leads to a sub-optimal experience for patients. Aim We aimed to identify the practices surrounding the diagnosis and treatment of UTIs in elderly patients within Royal Bolton Hospital, a large district general hospital in the North-West of England. We also aimed to identify unique patterns of presentation of UTIs in elderly patients which could lead to diagnostic difficulty. Finally, we assessed local antibiotic resistance rates. Methods A retrospective case-note analysis of 100 patients, over the age of 65 years, diagnosed with UTI was carried out in 3 cycles between 2016–2018. The final cycle was conducted following removal of Trimethoprim from antibiotic guidance. Results Of patients diagnosed with UTI and had MSU (mid-stream urine) sample analysed, only 28.8 % displayed microbial growth. 39.1 % of patients with confirmed UTI displayed neither signs nor symptoms of UTI. 20 % diagnosed with UTI did not have a MSU sample requested. Resistance rates of 39.1 % were reported to Trimethoprim, with E. coli accounting for 56.5 % of all UTIs. Conclusions Diverse presentation and incomplete diagnostics contributes to misdiagnosis of UTI. Trimethoprim is not an effective treatment option and guidelines should reflect this.