That Might Not Be a UTI

Urinary tract infections overly diagnosed in older women visiting emergency departments

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Ladies, take a second before starting any treatments at the hospital for pressure in the belly or pain when using the bathroom. That urine test might need to be done again.

Older women were overly diagnosed and treated for urinary tract infections (UTI) when visiting the emergency room at the hospital, a recently published study found.

Using catheters during a urinalysis for urinary tract infections may be more accurate than other methods, according to the researchers.

"Unsure of a diagnosis? Get a second opinion."

Lesley Gordon, MS, from the Warren Alpert Medical School at Brown University in Providence, Rhode Island, led an investigation into how often older women are diagnosed with and treated for UTIs when visiting a hospital emergency department.

The study included 153 women over 70 years of age who were diagnosed with a UTI at an emergency department in Providence, Rhode Island between December 2008 and March 2010.

Patients reported their symptoms and submitted urine samples. Researchers noted the methods used to take the samples (either through a catheter or caught in a cup), as well as the antibiotics prescribed and administered to patients.

A UTI diagnosis was defined as having 10,000 colony-forming units of microbial growth per milliliter or more in urine caught in a cup. UTIs were also defined as having 100 colony-forming units of microbial growth per milliliter in urine drawn through a catheter.

Researchers found that 57 percent of the patients had confirmed cases of UTI. Of the remaining individuals who had negative culture samples, 95 percent were still given or prescribed antibiotics in the emergency room.

The way in which urine samples were drawn affected whether UTIs were correctly diagnosed. Using a catheter versus catching urine in a cup resulted in fewer false-positive urinalyses.

A false-positive result means that the results appeared to be positive for the UTI, but were actually incorrect.

About 31 percent of urinalyses conducted through catheter usage resulted in false-positives while 48 percent of those using the clean catch method had false positives.

"These subjects were exposed to antibiotics unnecessarily, and the true etiology of their complaints may have gone undiagnosed," the researchers wrote in their report.

"Inappropriate antibiotic use in the emergency department for presumed UTI has been associated with antimicrobial resistance and undesired side effects because antibiotics are the second leading class of drugs to cause adverse events in individuals aged 65 and older," they wrote.

The authors noted a few limitations to their study, including not knowing the kind of lab work that the doctors performed when diagnosing the UTIs.

In addition, the ways in which urine samples were drawn were not assigned randomly to the patients, and researchers relied on nurses to accurately report the procedures used.

The study was published online April 16 in the Journal of the American Geriatrics Society. Funding information was not available and no conflicts of interest were declared.

Reviewed by: 
Review Date: 
April 26, 2013
Last Updated:
November 8, 2013