Guideline commentary on updated NICE guidelines for urinary tract infections

Abstract

... Urinary tract infection (UTI) accounts for 1–3% of primary care consultations and 13.7% of community antibiotic prescriptions in the UK; worldwide, UTI affects around 92 million people annually [1]. The incidence of UTI increases with age and it is the most commonly diagnosed infection in long-term care facilities [2, 3], where 1-year recurrence rates are as high as 50% [4]. Although updated NICE guidance is timely [5], they do not seem to have fully taken account of older people for whom UTI is a common presentation. Ruling UTI in or out can be especially difficult in older people who often present with ‘atypical’ or non-specific presentations. Non-specific presentations include immobility, confusion, falls, incontinence (the ‘geriatric giants’ [6]) and reduced functional abilities [7–13]. It can be difficult to assess lower urinary tract symptoms (LUTS) in older patients due to cognitive impairment and the high prevalence of chronic LUTS that are seen in conditions such as overactive bladder and genitourinary syndrome of menopause [14].