The uncertainties of the diagnosis and treatment of a suspected urinary tract infection in elderly hospitalized patients.

INTRODUCTION: The diagnostic criteria for a urinary tract infection (UTI) and proper treatment of elderly patients hospitalized with nonspecific symptoms is uncertain. Areas covered: A nonsystematic literature review of the variable approaches in diagnosing and treating hospitalized elderly patients with a suspected UTI. Expert commentary: Bacteriuria and/or pyuria cannot confirm the diagnosis of a UTI because of the high prevalence in the elderly regardless of presentation so urine cultures are not indicated in those hospitalized for diseases outside the urinary tract. The microscopic urinalysis is imprecise and inaccurate, and lowers the sensitivity in detecting a bacteremic UTI if used to confirm a positive dipstick test result. There is some evidence that cancelling urine cultures in the absence of a positive dipstick (negative leukocyte esterase and nitrite) is safe and prevents unnecessary antibiotic therapy. Urinary catheterization to obtain a urine sample is common in the elderly and it is unclear if changes in antibiotic therapy based on culture results outweighs the risks of the procedure. In hospitalized elderly patients without septic shock, it is unclear when it is safe to withhold antibiotic therapy, and when patients with criteria used to define severe sepsis need immediate treatment with broad-spectrum antibiotics.