Ditch the Dipstick – for patients >65Yrs or Catheterised!

Approx. 50% of over 65’s and most of those with catheters have asymptomatic bacteriuria. The patient will not benefit from treatment and often gives us premature closure (i.e. we blame a fictitious UTI for the patients symptoms and stop thinking).

Recommendation

1. Think Sepsis! – If the patient is septic treat as guidance
2. Look for Signs & Symps of UTI – us the indicators below
   • New dysuria (alone)
   • OR 2 of the following:
     • Temp 1.5°C above their norm (twice in 12hr) OR Hypothermia
     • New frequency/urgency
     • New incontinence
     • New/Worsening delirium/debility*
     • New suprapubic/flank pain
     • Visible haematuria
3. Consider UTI in older patients with: pyrexia, hypothermia, abnormal WCC or CRP AND no alternative cause for these.

*Confusion does not always mean infection. Consider other causes such as dehydration, constipation, medication etc. 

Management

• Only treat based on documented clinical signs and symptoms.
• Send an MSU for culture before commencing antibiotics.
• Follow antibiotic guidance