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Urinary tract infections. Does the smell really tell?
Susan J Midthun1, Ruth Paur, Glenda Lindseth
1Laboratory Science Program, Department of Pathology, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota.
Journal of Gerontological Nursing
|July 2, 2004
Summary
Malodorous urine is an unreliable indicator of urinary tract infections (UTIs) in elderly, incontinent nursing home residents. Relying on urine odor for UTI diagnosis leads to significant errors in this population.
Area of Science:
- Gerontology
- Infectious Diseases
- Urology
Background:
- Asymptomatic bacteriuria is often benign in older adults.
- Urinary tract infection (UTI) diagnosis requires symptoms and significant bacteriuria.
- Classic UTI symptoms are often absent or misleading in the elderly.
Purpose of the Study:
- To evaluate urine odor as a predictor of UTIs in incontinent, elderly nursing home residents.
- To assess the accuracy of urine odor compared to laboratory diagnostics for UTI detection.
Main Methods:
- Ninety-seven wet incontinence pads were assessed for odor within 1 hour of voiding.
- Odor results were compared with microscopy and culture of clean-catch urine samples.
- UTI was defined as bacteriuria or bacteriuria with pyuria.
Main Results:
- Urine odor was an inaccurate predictor of UTIs in one-third of cases.
- The smell of urine in incontinence pads is not a reliable symptom for UTI diagnosis in this population.
Conclusions:
- Urine odor is an unreliable symptom for diagnosing UTIs in elderly, incontinent nursing home residents.
- Over-reliance on urine odor can lead to diagnostic errors and potentially inappropriate antibiotic use.