Heartbeat: Don’t take the pee! For older patients, urine dips are not the key!

September 12, 2019

Urinary tract infection (UTI) is a common diagnosis in community and inpatient settings in our Trust. The infection is caused by bacteria in the urine, and is treated with short courses of antibiotics. However evidence is now showing that clinicians should show caution when reaching for the dip sticks when diagnosing UTIs in older patients.

The presence of bacteria in urine causing infection can be suggested by the symptoms that the patient has – for example pain, frequency and strong smell when passing urine, and is often confirmed by the use of a urine dip stick test which can test for blood and bacteria.

However one fact that is often overlooked is that it is possible for patients to have bacteria in their urine, but not have an underlying infection. This occurs in up to 50 per cent of patients over the age of 65 years, and up to 100 per cent of patients who have a urinary catheter in situ.

It is for this very reason that we advise that urine dip sticks should not be used to diagnose UTI in patients over 65 years old, or any patient with a catheter.

We all know that with antibiotic resistance on the rise, few new antibiotics coming to the market and we have to use the ones we have more carefully now.

Antibiotics are not harmless medicines in themselves – they can have a whole host of side effects, they can interact with a patient’s existing medicines and they can cause upset stomachs, diarrhoea and worst of all, Clostridium difficile infection.

For elderly patients with bacteria in their urine but no infection, it only takes three patients to be treated with antibiotics for one patient to be caused harm. Because so many elderly patients have asymptomatic bacteriuria, a misdiagnosis due to dip stick tests is likely to lead to the inevitable prescription for antibiotics, potential harm to the patient, driving the development of antibiotic resistance, and wasting money on unnecessary treatment.

If you think an elderly patient (over 65 years of age) has a urinary tract infection, the decision to give them antibiotics should be based on the symptoms they have, or the results of a urine culture. Don’t dip their urine to check for infection.

It is okay to dip an elderly patient’s urine to test for other things, such as protein, blood and so on, which are helpful to make other diagnoses. It’s just not helpful for working out if they have a UTI.