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- Page navigation anchor for Antibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysisAntibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysis
Many thanks for highlighting this complex but common issue regarding the prescription of antibiotics in the older patient based upon urine dipstick results, without other conclusive evidence of a urinary tract infection.1 As you have noted, this risks harm to the patient from adverse effects of inappropriate antibiotics and to the wider population from fostering antibiotic resistance.
This issue has been a key topic of discussion in recent years and has led to multiple campaigns surrounding the notion of “To dip or not to dip” and has led to Public Health England publishing guidance that urine dipstick analysis is not performed in adults aged over 65 presenting with “urinary signs/symptoms, abnormal temperature or non-specific signs of infection”.2I wonder if further clarification of the presentation of the patients in these studies would be helpful, so that those presenting non-specifically unwell are differentiated from those presenting with lower urinary tract symptoms. While the notion that asymptomatic bacteriuria is not harmful is certainly true, the same cannot be said for un-investigated lower urinary tract symptoms, which may represent sinister pathology, including underlying urological malignancy.
I have been concerned about how the problem of asymptomatic bacteriuria has led to “demonisation of the dipstick” and its decreased use as a vital diagnostic tool. The presence of leukocyte...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Antibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysisAntibiotics versus no treatment for asymptomatic bacteriuria in residents of aged care facilities: a systematic review and meta-analysis
Many thanks to the authors for this review. Although it has been clear for a while and is increasingly so, it's an important reminder that older people in residential care can develop non-specific symptoms for many reasons, and a positive urine dip is not nearly conclusive evidence that the cause is the ever-suspected "UTI".
Regarding the studies analysed - it is (as the authors acknowledge) difficult to assess the clinical condition of the participants - in practice, it is almost always the case that the patient being discussed has "something" e.g. acute confusion, drowsiness, reduced appetite etc - which has led to the urinalysis in the first place. Although on further questioning, UTI-specific symptoms such as suprapubic pain, dysuria, frequency or urgency are often absent (usually complicated by the patient's background cognitive impairment making communication of symptoms difficult).
Is there any distinction to be made in further research between completely asymptomatic patients, those with non-specific symptoms, and those with symptoms that truly are indicative of UTI?
Competing Interests: None declared.