Prevalence of delirium and urinary tract infection in a psychogeriatric unit

A retrospective study involving 407 patients discharged over a 2-year period from a psychogeriatric unit found that 83 (20.4%) had urinary tract infection (UTI) and 54 (13.3%) had delirium diagnoses at admission. Of the 54 with delirium, 14 (25.9%) had UTI. Of these 14 patients, delirium cleared in nine (64.3%) after appropriate treatment of UTI, two (14.3%) improved with treatment of concomitant medical disorders, and three (21.4%) did not improve. Only six of the 14 (42.8%) showed symptoms of UTI, with only one of the 14 (7.1%) showing fever and leukocytosis. Urine analyses were abnormal in all cases with 13/14 (92.8%) having positive cultures. Dementia was an associated risk factor in 71.4% of the 14 patients with UTI and delirium. Clinicians need to have a high index of suspicion relative to the presence of UTI in the elderly, especially with pre-existing cognitive impairment, since it can precipitate delirium. Early recognition and appropriate treatment decreases morbidity.