Skip to main content
SpringerLink
Log in

Investigation and treatment of asymptomatic bacteriuria in older patients with delirium: a cross-sectional survey of Canadian physicians

  • Original Research
  • Published:
Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Objectives

Current guidelines suggest assessing non-infectious causes and careful observation before giving antibiotics to delirious patients with asymptomatic bacteriuria. Our study aims to describe the current practice of Canadian physicians regarding the investigation and treatment of asymptomatic bacteriuria in delirious older patients (aged ≥ 65 years).

Methods

Our team of medical experts designed and reviewed a cross-sectional online survey. Study participants were physicians who conduct their clinical practice in Canada and care for older patients with delirium in their current practice. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec and members of Choosing Wisely Canada.

Results

297 physicians were included. The main results show 79.4% of our participants request a urine dipstick or urinalysis in delirious patients and 52.4% immediately order a urine culture with the urinalysis. If bacteriuria is found in delirious but afebrile patients without urinary symptoms, 38% of physicians immediately treat with antibiotics, 33.8% wait for culture before initiating treatment, 14.4% treat if no other cause is found for delirium and only 13.7% would refrain from giving antibiotics. Results from respondents were similar for delirious patients with known cognitive impairment. Participants were almost unanimous (92.5%) in saying they need clear guidelines regarding the treatment of bacteriuria in older delirious patients.

Conclusions

This survey highlights the heterogeneous clinical management of asymptomatic bacteriuria in delirious patients and the need for clear guidelines for patients.

Résumé

Objectifs

Les directives actuelles suggèrent d'évaluer les causes non infectieuses et de procéder à une observation attentive avant d'administrer des antibiotiques aux patients délirants présentant une bactériurie asymptomatique. Notre étude vise à décrire la pratique actuelle des médecins canadiens concernant l'investigation et le traitement de la bactériurie asymptomatique chez les patients âgés délirants (âgés ≥ 65 ans).

Méthodes

Notre équipe d'experts médicaux a conçu et examiné une enquête transversale en ligne. Les participants à l'étude étaient des médecins qui exercent leur pratique clinique au Canada et qui soignent des patients âgés atteints de délire dans leur pratique actuelle. Les participants potentiels à l'étude ont été contactés par le biais d'associations canadiennes: Société Canadienne de Gériatrie, l'Association Canadienne des Médecins d'Urgence, l'Association des Médecins d'Urgence du Québec et les membres de Choisir avec soin (Choosing Wisely Canada).

Résultats

297 médecins ont été inclus. Les principaux résultats montrent que 79,4% de nos participants demandent une bandelette urinaire ou une analyse d'urine chez les patients délirants et 52,4% demandent immédiatement une culture d'urine avec l'analyse d'urine. En cas de découverte d'une bactériurie chez des patients délirants mais afébrile sans symptômes urinaires, 38% des médecins traitent immédiatement avec des antibiotiques, 33,8% attendent la culture avant de commencer le traitement, 14,4% traitent si aucune autre cause n'est trouvée pour le délire et seulement 13,7% s'abstiendraient de donner des antibiotiques. Les résultats des répondants étaient semblables chez les patients délirants ayant une déficience cognitive connue. Les participants étaient presque unanimes (92,5%) à dire qu’ils avaient besoin de lignes directrices claires concernant le traitement de la bactériurie chez les patients délirants plus âgés.

Conclusions

Cette étude met en évidence la prise en charge clinique hétérogène de la bactériurie asymptomatique chez les patients délirants et la nécessité de lignes directrices claires pour les patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and material

Available upon reasonable request.

References

  1. Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry. 2004;12(1):7–21.

    Article  Google Scholar 

  2. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet (London, England). 2014;383(9920):911–22. https://doi.org/10.1016/s0140-6736(13)60688-1.

    Article  Google Scholar 

  3. Todd OM, Teale EA. Delirium: a guide for the general physician. Clin Med (Lond). 2017;17(1):48–53. https://doi.org/10.7861/clinmedicine.17-1-48.

    Article  Google Scholar 

  4. Canadian Coalition for Seniors’ Mental Health. National guidelines for seniors’ mental health. 2006.

  5. Canadian Geriatrics Society. Five things physicians and patients should question (Geriatrics). Choosing Wisely Canada. 2017. https://choisiravecsoin.org/geriatrie/.

  6. Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the infectious diseases society of America. Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciy1121.

    Article  PubMed  Google Scholar 

  7. Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT, Leibovici L. Antibiotics for asymptomatic bacteriuria. Cochrane Database System Rev. 2015;4:Cd009534. https://doi.org/10.1002/14651858.CD009534.pub2.

    Article  Google Scholar 

  8. Trautner BW. Asymptomatic bacteriuria: when the treatment is worse than the disease. Nat Rev Urol. 2011;9(2):85–93. https://doi.org/10.1038/nrurol.2011.192.

    Article  CAS  PubMed  Google Scholar 

  9. Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014;311(8):844–54. https://doi.org/10.1001/jama.2014.303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Nicolle LE. Urinary tract infections in the older adult. Clin Geriatr Med. 2016;32(3):523–38. https://doi.org/10.1016/j.cger.2016.03.002.

    Article  PubMed  Google Scholar 

  11. AMMI Canada. Asymptomatic bacteriuria. In: Symptom-Free Pee: LET IT BE. 2018. https://www.ammi.ca/?ID=127&Language=ENG.

  12. Finucane TE. “Urinary tract infection”-Requiem for a heavyweight. J Am Geriatr Soc. 2017;65(8):1650–5. https://doi.org/10.1111/jgs.14907.

    Article  PubMed  Google Scholar 

  13. Michels TC, Sands JE. Dysuria: evaluation and differential diagnosis in adults. Am Fam Physician. 2015;92(9):778–86.

    PubMed  Google Scholar 

  14. Mayne S, Bowden A, Sundvall PD, Gunnarsson R. The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review. BMC Geriatr. 2019;19(1):32. https://doi.org/10.1186/s12877-019-1049-7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. McKenzie R, Stewart MT, Bellantoni MF, Finucane TE. Bacteriuria in individuals who become delirious. Am J Med. 2014;127(4):255–7. https://doi.org/10.1016/j.amjmed.2013.10.016.

    Article  PubMed  Google Scholar 

  16. Balogun SA, Philbrick JT. Delirium, a symptom of UTI in the elderly: fact or fable? A systematic review. CGJ. 2014;17(1):22–6. https://doi.org/10.5770/cgj.17.90.

    Article  PubMed  Google Scholar 

  17. Suleman A, Krakovsky J, Joo P. LO15: Treatment of asymptomatic bacteriuria in elderly patients with delirium: a systematic review. CJEM. 2018;20(S1):S11–2. https://doi.org/10.1017/cem.2018.77.

    Article  Google Scholar 

  18. Dillman D. Mail and internet surveys: The tailored design method, 2nd ed. 2007.

  19. Burns KEA, Duffett M, Kho ME, Meade MO, Adhikari NKJ, Sinuff T, et al. A guide for the design and conduct of self-administered surveys of clinicians. Can Med Assoc J. 2008;179(3):245–52. https://doi.org/10.1503/cmaj.080372.

    Article  Google Scholar 

  20. Juthani-Mehta M, Drickamer MA, Towle V, Zhang Y, Tinetti ME, Quagliarello VJ. Nursing home practitioner survey of diagnostic criteria for urinary tract infections. J Am Geriatr Soc. 2005;53(11):1986–90. https://doi.org/10.1111/j.1532-5415.2005.00470.x.

    Article  PubMed  Google Scholar 

  21. Institut national d’excellence en santé et en services sociaux (INESSS). Urinary tract infection in adults. Québec, Qc: INESSS; 2017. p. 1–62.

  22. Urinary tract infection (UTI) program implementation guide, (2019).

  23. Blondel-Hill E, Patrick D, Nott C, Abbass K, Lau TT, German G. AMMI Canada position statement on asymptomatic bacteriuria. Offic J Assoc Med Microbiol Infect Dis Canada. 2018;3(1):4–7. https://doi.org/10.3138/jammi.3.1.02.

    Article  Google Scholar 

  24. Averbeck MA, Rantell A, Ford A, Kirschner-Hermanns R, Khullar V, Wagg A, et al. Current controversies in urinary tract infections: ICI-RS 2017. Neurourol Urodyn. 2018;37(S4):S86–92. https://doi.org/10.1002/nau.23563.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge all of the clinicians who responded to the survey for this study. Special thanks to Pierre-Hugues Carmichael for his help with statistical analysis and all authors for their respective participation.

Funding

AL received a Master’s student award from the Université Laval. The funder played no role in the design or conduct of this study.

Author information

Authors and Affiliations

  1. Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec – Université Laval, 1401, 18ièmerue, Québec, QC, G1J 1Z4, Canada

    Antoine Laguë, Valérie Boucher & Marcel Émond

  2. VITAM - Centre de Recherche en Santé Durable, Québec, QC, Canada

    Antoine Laguë, Valérie Boucher & Marcel Émond

  3. Faculté de Médecine, Université Laval, Québec, QC, Canada

    Antoine Laguë, Valérie Boucher, Charles Morasse & Marcel Émond

  4. Centre D’Excellence Sur Le Vieillissement de Québec, Québec, QC, Canada

    Valérie Boucher & Marcel Émond

  5. University of Ottawa, Ottawa, ON, Canada

    Pil Joo

  6. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada

    Pil Joo & Krishan Yadav

  7. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Pil Joo & Krishan Yadav

Authors
  1. Antoine Laguë
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valérie Boucher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pil Joo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Krishan Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles Morasse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcel Émond
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcel Émond.

Ethics declarations

Conflicts of interest

None.

Ethics approval

The CHU de Québec-Université Laval Research Ethics Board approved this study (#2020–4911).

Consent to participate

Responding to the survey questions constituted a consent to participate, as stated in the information page preceding the survey itself.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 235 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laguë, A., Boucher, V., Joo, P. et al. Investigation and treatment of asymptomatic bacteriuria in older patients with delirium: a cross-sectional survey of Canadian physicians. Can J Emerg Med 24, 61–67 (2022). https://doi.org/10.1007/s43678-021-00148-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43678-021-00148-1

Keywords

Search

Navigation