The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure.
Laura W van Buul, Hilde L Vreeken, Suzanne F Bradley and 15 others
PMID 29910137WHAT IT FOUND
A positive urine dipstick alone should not trigger antibiotics in frail older adults with urinary tract symptoms.
Expert consensus recommends using dipstick mainly when both nitrite and leukocyte esterase are negative, which rules out UTI.
Key findings
01In frail older adults with urinary tract symptoms, dipstick results should not influence antibiotic treatment unless both nitrite and leukocyte esterase are negative, which rules out UTI.
02Systemic signs such as fever, rigors, delirium, hypotension, hypothermia, and tachycardia were not included in the symptom table because experts considered them possibly caused by UTI but also possibly by other causes, and their relevance depended on other symptoms.
03Consensus was reached on not prescribing antibiotics for 8 clinical scenarios and on prescribing antibiotics for 5; 5 scenarios did not reach consensus, though 4 tended toward prescribing, and there were no gender differences.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No patients were enrolled or followed, so the study does not show that the tool improves outcomes or reduces antibiotic use. The result is expert consensus, not a tested intervention. Consensus was not reached for 5 clinical scenarios, and agreement levels were close to the threshold in 3 of them (69% to 71%). Frail older adults was not defined in the questionnaire rounds, although panel members later said they had the described population in mind. The panel was small and physician-only, with no nurses, patients, or families participating. The authors note that some clinical scenarios may not be covered by the tool.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as evidence that the decision tool reduces inappropriate antibiotics or improves patient outcomes. It was developed by 16 experts and has not been tested in patients.