118URINALYSIS AND UTI IN GERIATRIC PATIENTS - A REVIEW OF PERFORMANCE IN A DISTRICT GENERAL HOSPITAL

Abstract

Introduction: Dipstick urinalysis is a cheap, quick, and simple bedside investigation. While there are issues with asymptomatic bacteriuria and potential inappropriate antibiotic use in the elderly, urinary tract infection (UTI) remains a common and potentially serious condition in these patients. Urinalysis can effectively exclude UTI (Devillé et al., BMC Urol, 2004, 4:4), and considering geriatric patients frequently present atypically with more non-specific signs and symptoms of infection (Gavazzi & Krause, The Lancet Infectious Diseases, 2002, 11:655), urinalysis remains worthwhile. As such we decided to review the use of urine dipsticks in our Trust. Methods: Over one month we reviewed patient records recording: indication for urinalysis, urinalysis done/not done (admission complaint only) and results, medical plan requesting urinalysis, and documentation for why urinalysis/culture sample was not sent. This was a convenience sample of 30 randomly selected inpatients >75 years old, on a geriatric ward. Results: The mean patient age was 87.5 (76-100) years old. There was documented suspicion of infection where UTI could not be excluded and/or renal impairment in 28/30 (93.3%). 9/28 (32.1%) of patients had neither urinalysis nor documentation as to why not, 4/9 (44.4%) of these had no medical plan requesting urinalysis. 5/28 (17.9%) patients had a medical plan requesting urinalysis but it was not done. 12/20 (60%) dipsticks were positive for leucocytes and/or nitrites, and 11/12 (91.7%) of these were sent for culture. 16/20 (80%) of dips were done in the ED or AMU. Conclusions: Our review suggests urinalysis is justified in the majority of geriatric admissions. We also demonstrated it is still poorly carried out with 32% of indicated dipsticks not completed. Common reasons for requesting included: confusion or infection of unknown origin, in addition to patients with high suspicion of UTI with a need to determine a causative organism. We therefore recommend that despite recent guidance potentially suggesting otherwise, Geriatricians should still consider urinalysis as a crucial investigation for the majority of geriatric patients.