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Margot Gosney, Reply, Age and Ageing, Volume 36, Issue 3, May 2007, Page 353, https://doi.org/10.1093/ageing/afm025
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Extract
SIR—We thank Drs McAdam et al. for their comments on our study. Our study was to highlight the difficult issue of the diagnosis of significant urinary tract infections in elderly hospital inpatients. Our 1-day study highlighted that:
We hope we highlighted, as Dr McAdam and colleagues have done, that a gold standard of the diagnosis of a urinary tract infection does not exist in elderly hospital inpatients. Our lack of positive cultures, we agree, may be due to the laboratory cell counters missing some positive samples. We did, as part of our study, however, look at levels of colony-forming units per cubic centimetre (cfu/mm3) of urine and assessed 103 as being significant for the purposes of our study.
At a time of increasing cases of Clostridium difficile diarrhoea, as well as antibiotic-associated diarrhoea, antibiotic prescribing for the ‘presumed UTI’, which we all see as poor practice in many emergency and clinical decision units, must be highlighted and challenged. We must encourage all elderly patients with a presumed diagnosis of a urinary tract infection to have a urine dipstick test, plus urine to be sent for microscopy and culture, to ensure that antibiotics are carefully targeted for documented organisms, and if later cultures suggest lack of sensitivity, appropriate antimicrobial agents can be substituted.
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