Patterns of Urine Testing and Antibiotic Use for Atypical UTI Symptoms in Cognitively Impaired Long-Term Care Residents: A Retrospective Study of Diagnostic Criteria Adherence

Diagnosing urinary tract infection (UTI) in patients with impaired communication is challenging due to reliance on subjective symptoms. This study compared diagnostic criteria fulfillment, the results of urine testing, and antibiotic use for atypical UTI symptoms between verbal patients and those with impaired communication in a long-term care (LTC) setting.

In this cross-sectional study, we retrospectively analyzed 127 urinalyses and urine cultures ordered between January 1 and December 31, 2023, from 83 patients in an LTC facility in New York, USA. Data included demographics, comorbidities, reasons for urinalysis, results, and antibiotic use. We assessed the adherence to Loeb's diagnostic and treatment criteria and the updated McGeer criteria.

Patient background characteristics did not differ significantly between groups. Among non-catheterized patients, verbal patients were significantly more likely to meet the Loeb diagnostic criteria (54.7% vs 20.8%, p=0.005), Loeb treatment criteria (42.2% vs 12.5%, p=0.009), and updated McGeer criteria (50.0% vs 20.8%, p=0.014), while rates of pyuria (90.5% vs 83.3%, p=0.435) and positive urine culture (75.0% vs 66.7%, p=0.434) did not differ. These findings suggest a higher prevalence of asymptomatic bacteriuria in patients with impaired communication. Among catheterized patients, there were no significant differences between groups in meeting diagnostic criteria. Antibiotics were prescribed for over 90% of patients in both groups whose urine samples were collected.

Patients with impaired communication are less likely to meet established UTI diagnostic criteria despite similar urine test positivity, indicating possible overdiagnosis and overtreatment. Further research is needed to develop and implement a modified diagnostic algorithm tailored to the unique clinical presentation of LTC residents with impaired communication. High antibiotic prescription rates emphasize the need to reduce unnecessary tests to minimize inappropriate antibiotic use.