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• W1512336504 abstract "To the Editor: The article by Juthani-Mehta et al.1 illustrates the dilemma facing clinicians taking care of residents of long-term care facilities (LTCFs). As the authors proposed, “a different combination of existing clinical criteria and geriatric manifestations will be more accurate.” The challenge is how to differentiate the clinical manifestations of urinary tract infection (UTI) from coexisting comorbidities in older adults. One study of 284 geriatric patients with UTI in the emergency department considered the following symptoms as possible manifestations of UTI: abdominal pain, nausea, vomiting, decreased appetite, dizziness, malaise, weakness, confusion, falls, and mental status changes.2 Most of the symptoms, if not all, are based on clinical observation and have not been validated by clinical research studies. In addition, these symptoms are clearly nonspecific, although findings from other studies suggest an indirect link between episodes of falls and UTI, because older adults with UTI may experience delirium, which can lead to falls and fractures. A prospective study of 199 patients in five residential care facilities during 1 year of follow-up revealed that delirium and acute UTI were considered major factors precipitating falls.3 A case-control study of 335 residents living in an LTCF revealed that altered mental state was recognized as the most important risk factor for injury in those who fell,4 although a direct link between falls and UTI has not been demonstrated. The effect of UTI on the functional capacity (e.g., oral intake, activities of daily living) of residents of LTCFs is not clear. A prospective study of 1,324 residents in 39 nursing homes in western Switzerland examined the relationship between infections and functional impairment (defined as death or a decreased activity of daily living score at the end of each follow-up period) in residents of LTCFs during a 6-month follow-up period.5 This study revealed that infection appeared to be a cause and a consequence of functional impairment in nursing home residents, although subgroup analyses based on the type of infection revealed no significant increase in the risk of functional impairment for UTI. A 3-month period between functional assessments in this study may not have been sufficiently sensitive to detect transient changes in functional status during an episode of UTI. Because of their nonspecific nature, apart from local urinary tract symptoms and fever, geriatric manifestations of UTI in elderly people in LTCFs may not be sufficient to differentiate UTIs from other coexisting disorders. Presently, the individual healthcare provider must make the final judgment as to when to order urinalysis and whether a patient with bacteriuria has a UTI and should therefore receive antibiotics.6 More evidence-based studies are needed to clarify this dilemma facing clinicians in the care of elderly people in the long-term care setting. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklists provided by the author and has determined that none of the authors have any financial or any other kind of personal conflicts with this letter. Author Contributions: Dr. Gau is responsible for the letter. Dr. Clay contributed to the editing and preparation of the letter. Sponsor's Role: None." @default.
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• W1512336504 date "2008-03-01" @default.
• W1512336504 modified "2023-09-27" @default.
• W1512336504 title "DIAGNOSTIC ACCURACY OF CRITERIA FOR URINARY TRACT INFECTION IN NURSING HOMES" @default.
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• W1512336504 doi "https://doi.org/10.1111/j.1532-5415.2008.01583.x" @default.
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