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Febrile urinary infection in the institutionalized elderly
P H Orr1, L E Nicolle, H Duckworth
1Department of Internal Medicine, Winnipeg, Canada.
The American Journal of Medicine
|January 1, 1996
Summary
Urinary tract infections contribute to less than 10% of fevers in elderly residents with bacteriuria. Clinical definitions for urinary infections are less accurate than serologic criteria, and bacteriuria has low predictive value for fever.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Bacteriuria (bacteria in urine) is common in elderly individuals residing in long-term care facilities.
- The actual contribution of urinary tract infections to fever in this population is not well understood due to diagnostic challenges.
Purpose of the Study:
- To determine the proportion of febrile episodes in institutionalized elderly residents attributable to urinary infections.
- To compare clinical and serologic criteria for identifying urinary tract infections as a cause of fever.
Main Methods:
- Prospective study of fever episodes in residents of two long-term care institutions over 2 years.
- Collection of serum and urine specimens for analysis.
- Assessment of urinary infection contribution using standard clinical criteria and serum antibody response to uropathogens.
Main Results:
- Of 372 fever episodes, only 26 (7%) were clinically identified as genitourinary tract infections.
- Serologic criteria indicated urinary infection in 8.3% of episodes with paired sera, with higher rates in clinically identified genitourinary infections (43%) and unknown origins (11%).
- Bacteriuria had a low positive predictive value (11-12%) for identifying febrile urinary infections by either clinical or serologic criteria.
Conclusions:
- Urinary infections account for less than 10% of clinically significant fevers in this high-prevalence bacteriuric elderly population.
- Serologic criteria are more reliable than restrictive clinical definitions for identifying fever of urinary origin.
- Bacteriuria alone is a poor predictor of febrile urinary infection in this setting.
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