Age Is Not an Indication: Antibiotic Agents for Urinary Tract Infections in Patients with Geriatric Trauma

Geriatric patients injured in traumatic falls may present with either baseline or acquired cognitive impairment, preventing them from describing genitourinary symptoms. Thus, they are frequently given a screening urinalysis (UA) for possible urinary tract infection (UTI). However, according to the Infectious Diseases Society of America (IDSA), patients without systemic signs of infection should be assessed for other causes of falls and instead closely monitored. We conducted a study in our trauma system to assess UTI screening and treatment. We hypothesized that geriatric falls are likely to receive unnecessary urinalyses (UAs) and antibiotic agent treatment.

Our trauma registry was queried for all patients with trauma aged 65 years and older between 2020 and 2023 for a ground-level fall with an initial Glasgow Coma Score (GCS) <15. Individual charts were reviewed for UTI testing and treatment data.

Two hundred and sixty-eight out of 489 patients with geriatric falls (54.8%) had a screening UA performed. One hundred and fifteen (42.9%) patients had positive UAs. Of those with positive UAs, 69/115 (60%) patients were initially given antibiotic agent therapy for UTI treatment. There was no correlation between UTI treatment and either sepsis on presentation (p = 0.65), change in GCS (p = 0.21), or mortality rate (p = 0.16). Of all UAs done, 263/268 (98.1%) were given to patients without a systemic sign of infection.

Geriatric patients with cognitive impairment that were injured in falls were consistently over-tested and overtreated for UTIs. Application of IDSA guidelines can potentially reduce unnecessary antibiotic agent use in these patients.