Urinary Tract Infection

Urinary tract infections (UTIs) are among the most common infections seen in post-acute and long-term care (PALTC) settings, particularly among older women and individuals with indwelling urinary catheters. Their presence, often accompanied by subtle or atypical symptoms in older adults, requires careful clinical assessment to ensure timely and appropriate intervention.

Critical Points for PALTC Providers

• Recognizing Atypical Presentations: Older adults might not exhibit the classic symptoms of dysuria or flank pain. Instead, they may display altered mental status, generalized weakness, or even increased falls.
• Risk Factors in PALTC: Prolonged catheter use, urinary retention, recent antibiotic usage, and diabetes are among the key risk factors in this population.

Asymptomatic bacteriuria (ASB) and/or pyuria is common in residents in PALTC and is the major driver for overuse of antibiotics for UTI, leading to an increased risk of adverse drug events, resistant organisms, and infection due to Clostridioides difficile.  

Due to the high rate of bacterial colonization of urine in older adults, it is important to avoid obtaining a urinalysis or urine culture unless the resident has signs or symptoms suggestive of UTI such as dysuria, and one or more of the following: frequency, urgency, suprapubic pain or gross hematuria.