Delay in the diagnosis of bacteraemic urinary tract infection in elderly patients

Collaboration between clinicians and microbiologists revealed that many patients with subsequently proven urinary tract infection (UTI) present with symptoms suggestive of chest infection. A retrospective analysis was performed on patients over 50 years old with community acquired bacteraemic UTI proven by blood cultures. The main presenting features were confusion (30%), cough (27%), dyspnoea (28%) and new urinary symptoms (20%). The initial clinical diagnosis was UTI in 43% and chest infection in 24%. Chest infection was diagnosed more often in those over 70 years old than those aged 50-70 years old (chi 2 = 7.2, p = 0.007). The majority had pyuria but less than half of the urine samples arrived in the laboratory on the day of admission, fewer from the older patients than the younger (chi 2 = 2.57, p = 0.10). These results demonstrate that UTI frequently presents with respiratory features and that the diagnosis of UTI is often delayed. Sampling the urine with a catheter may be justified to enable diagnosis on the day of admission.