Abstract
BackgroundOverdiagnosis and overtreatment of urinary tract infection (UTI) with antibiotics is a concern. In older adults, diagnosis of UTI using near-patient urine tests (reagent strip tests, dipsticks) is advised against because the age-related increase in asymptomatic bacteriuria can cause false-positive results. Instead, UTI diagnosis should be based on a full clinical assessment. Previous research lacks systematic information on urine dipstick use in hospitals. The aim of this study was to examine the use of urine dipstick tests and microbiology among older adult hospital admissions in relation to recommended UTI diagnostic criteria. A further aim was to assess factors associated with the use of dipsticks.MethodsA case series review of patients aged ≥70 years admitted to two NHS Trust hospitals in England. Records from 312 patients admitted in 2015 meeting inclusion criteria were selected at random.ResultsOf 298 complete patient records, 54% had at least one urine dipstick test recorded. 13% (21/161) of patients who received a urine dipstick test were diagnosed as having a UTI, only 2 out of these 21 cases had two or more clinical signs and symptoms. 60 patients received a second dipstick test, leading to 13 additional cases of UTI diagnosis. Dipstick tests were more likely to be performed on patients with a history of falls (OR 1.93, 95% CI:1.21, 3.07, p < 0.01), and less likely on those with dementia (OR 0.44, 95% CI: 0.22, 0.87, p < 0.05). The most common reason for testing was routine admissions policy (49.1% of cases), but these cases were predominantly in one hospital.ConclusionsUse of urine dipstick tests was high among older adults admitted to hospitals. Most cases were asymptomatic and therefore received inappropriate antibiotic therapy. This paper highlights the need to implement new Public Health England diagnostic guidelines to hospital admission and emergency departments.
Highlights
Overdiagnosis and overtreatment of urinary tract infection (UTI) with antibiotics is a concern
The NICE quality standard (QS260) for older adults recommends that UTIs are diagnosed by a full clinical assessment, without urine dipstick testing, because of varying accuracy [6]
Previous studies of UTI diagnosis in hospitalised older adults have examined the use of microbiological culture and antibiotic sensitivity testing [12] but have not reported on the use of urine dipsticks
Summary
Overdiagnosis and overtreatment of urinary tract infection (UTI) with antibiotics is a concern. The aim of this study was to examine the use of urine dipstick tests and microbiology among older adult hospital admissions in relation to recommended UTI diagnostic criteria. The NICE quality standard (QS260) for older adults recommends that UTIs are diagnosed by a full clinical assessment, without urine dipstick testing, because of varying accuracy [6]. Previous studies of UTI diagnosis in hospitalised older adults have examined the use of microbiological culture and antibiotic sensitivity testing [12] but have not reported on the use of urine dipsticks. There are significant gaps in knowledge about the routine use of dipsticks and urine microbiology in hospital admissions and the diagnostic pathways for UTIs and antibiotic prescribing. Urine dipstick use is largely undocumented because it is often not captured through routine data
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