UTIs (Urinary Tract Infections)
What is it?
Urinary tract infections are the most common bacterial infection in the elderly population. UTIs are caused by bacteria entering the bladder through the urethra and multiplying within the urine in the bladder. Bacteria may also travel up to the kidneys and cause pyelonephritis, leading to bloodstream infections. These bacteria are usually the person's own bowel bacteria or may be introduced through a urinary catheter.
The presence of bacteria in the urine of an older person does not necessarily mean there is an infection. Bacteria can live in the urine of older people without causing any harm. This is called "asymptomatic bacteriuria". Data suggests that approximately 50% of older people have bacteria in the urine without causing any symptoms, and 100% of those older people with an indwelling catheter.
What are the signs and symptoms?
A UTI in an older person without a urinary catheter is defined as two or more of the following
Dysuria (pain on passing urine)
Urgency or Frequency (needing to pass urine urgently and often)
New or worsening urinary incontinence
Haematuria (visible blood in the urine)
A temperature less than 36˚C or above 38˚C
New or increased confusion or agitation
Suprapubic or flank pain (lower abdominal or back pain)
With a urinary catheter
Shivering or chills or a temperature less than 36˚C or above 38˚C
New or worsening confusion or agitation
Suprapubic pain or flank pain (lower abdominal or back pain)
Haematuria (visible blood in the urine)
Diagnosis
Urine dipsticks have been the most widely used tool to diagnose UTIs in the elderly. Urine dipsticks can detect the presence of nitrites and leukocyte esterase, which are indicators of possible UTIs, and many of these dipstick tests will be positive for bacteria, whether it is causing infection or not.
Urine dipsticks are NOT very helpful in diagnosing older people with a UTI as they can often mislead us into thinking a UTI is present. This can be harmful to the older person as we may miss another cause for the resident's symptoms and administer antibiotics inappropriately.
Using signs and symptoms is a more accurate way of assessing whether the resident has a possible UTI.
Best Practice Guidelines
Focus on the signs and symptoms and what actions need to be taken
To ensure the best and safest antibiotic choice, collecting a urine sample is critical
Urine samples could be either clean catch, mid-stream urine (MSU), or catheter specimen urine (CSU)
If the resident does not have any symptoms of a UTI, then infection is unlikely
If you are still concerned about the resident even though they do not have symptoms of a UTI, discuss with a clinician through the usual routes.
Need a urine sample?
As part of antimicrobial stewardship in residential aged care facilities, urine cultures are very important for diagnosing older people with UTIs. If an antibiotic is required to treat the infection, the lab results will inform the Doctor which antibiotic is safest and best to use and, if there is a resistant infection, an alternative that can be used.
Need a urine sample?
A urine sample is to be collected in the most sterile way possible
The container must have the relevant resident identifiers and indicate whether the urine is a clean catch, MSU, or a catheter sample, it must also be paired with the relevant lab order form.
It should be immediately sent to the pathology lab for microbiological testing. If a delay in transport is expected, the sample must be refrigerated as bacteria grows rapidly when a urine sample is left at room temperature, and this may change the lab results.
Contact the Doctor to review the lab results as soon as possible.
Can UTIs be prevented?
There are some ways that the incidence of UTIs can be reduced or prevented
Encourage adequate fluid intake
Avoid irritants for the urinary tract, such as tea, coffee, soft drinks, and alcohol
Educate residents and caregivers on proper wiping (from front to back)