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

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.

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.

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.

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.

Diverse presentation and incomplete diagnostics contributes to misdiagnosis of UTI. Trimethoprim is not an effective treatment option and guidelines should reflect this.