We should use a much higher leukocyte cutoff to diagnose UTI in older women

Clinical Question

What is the optimal leukocyte cutoff for diagnosing urinary tract infection in older women?

Bottom line

For women 65 years and older, we should use a much higher cutoff for pyuria before diagnosing UTI to avoid overtreating women who have asymptomatic bacteriuria. A limitation of this diagnostic case-control design is that it tends to overestimate the accuracy of a test, so a follow-up study using a cohort design and women with clinically suspected UTI should be done next. (LOE = 4)

Overuse alert: This POEM aligns with the Canadian Nurses Association’s Choosing Wisely Canada recommendation: Don’t recommend antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present. A patient handout is also available on reducing unnecessary antibiotic use.

Study design: Diagnostic test evaluation

Funding: Government

Setting: Outpatient (any)

Reviewer

Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA


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Comments

Roland Michael Grad

Diagnosing UTI

Should physicians in community-based practice still count leukocytes using microscopy, as a test for UTI? I diagnose based on clinical findings, or wait for a culture report.

Anonymous

Thresholds for UTI in elderly females

This confirms what Urologists have long known

ARUP KUMAR DHARA

Impact assessment

Excellent

Anonymous

LEUKOCYTS AND UTI IN OLDERWOMEN

GOOD TO KNOW