Geriatric MedicineTier 2Topic

Clinical issues - distinction between urinary tract infections and asymptomatic bacteriuria

Definitions

Asymptomatic bacteriuria (ASB) = significant bacteriuria (>=10^8 CFU/L, i.e. >=10^5 CFU/mL) on an appropriately collected specimen WITHOUT urinary symptoms
- Pyuria may be present - *pyuria does not make it an infection*
UTI = bacteriuria PLUS attributable symptoms or signs

Why this matters more in geriatrics than almost anywhere

Symptoms that define a UTI

Prevalence of asymptomatic bacteriuria

Pathogenesis and predisposing factors

The rule: decide clinically BEFORE sending the urine

Interpreting the dipstick

Specimen collection

The delirious older patient with a positive urine - how to think

When bacteriuria IS worth finding and treating

Asymptomatic bacteriuria - management

Symptomatic UTI in an older adult

Recurrent UTI - prevention without antibiotics first

Antimicrobial stewardship framing

Associations

Natural history of bacteriuria

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