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Older people

New guidelines for diagnosis of urinary tract infections in older people

Public Health England and NICE have released new guidelines on the diagnosis and management of UTIs, including advice for patients over 65 years of age.

The guidelines include a statement that urine dipsticks should not be used in this age group as they become more unreliable with increasing age over 65 years.

The first step in the correct diagnosis of urinary signs and symptoms is to check for sepsis or pyelonephritis (such as kidney pain, new myalgia, nausea, vomiting or rigors). If this has been excluded, new signs or symptoms of UTI should be checked for, including new onset dysuria alone or two or more of the following:

  • Temperature of more than 1.5c above normal values twice in the last 24 hours
  • New frequency or urgency
  • New incontinence
  • New or worsening delirium
  • New suprapubic pain
  • Visible haematuria

If a UTI is likely and depending on local resistance patterns, the first-line choice of antibiotics for those of over 65 would be a three-day course for women and a seven-day course for men of either nitrofurantoin (if eGFR > 45ml/min) or trimethoprim.

If a UTI is unlikely, the PINCH ME tool should be used for other possible causes of delirium (Pain, Infection, poor Nutrition, Constipation, poor Hydration, other Medication or Environmental changes). Other possible localised infections such as respiratory, gastrointestinal, skin or tissue should be checked for.

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