References

Abernethy J, Guy R, Sheridan EA Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme. J Hosp Infect. 2017; 95:(4)365-375 https://doi.org/10.1016/j.jhin.2016.12.008

Allison R, McNulty C Urinary tract infections: when is it appropriate to prescribe an antibiotic?. Guidelines in practice. 2019; https://bit.ly/2Nig5DS

Anderson C Exploring the role of advanced nurse practitioners in leadership. Nurs Stand. 2018; 33:(2)29-33 https://doi.org/10.7748/ns.2018.e11044

Balogun SA, Philbrick JT Delirium, a symptom of UTI in the elderly: fact or fable? a systematic review. Can Geriatr J. 2014; 17:(1)22-26 https://doi.org/10.5770/cgj.17.90

Urinary tract infections in women: aetiology. 2020; https://bestpractice.bmj.com/topics/en-gb/3000120

Bonkat G, Bartoletti R, Bruyère F EAU Urological Infections Guideline. 2020; https://uroweb.org/guideline/urological-infections/#1

Butler CC, Hawking MKD, Quigley A, McNulty CAM Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey. Br J Gen Pract. 2015; 65:(639)e702-e707 https://doi.org/10.3399/bjgp15x686965

Cove-Smith A, Almond MK Management of urinary tract infections in the elderly. Trends in Urology Gynaecology and Sexual Health. 2007; 12:31-34 https://doi.org/10.1002/tre.33

Chu CM, Lowder JL Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol. 2018; 219:(1)40-51 https://doi.org/10.1016/j.ajog.2017.12.231

Gau JT, Shibeshi MR, Lu IJ Interexpert agreement on diagnosis of bacteriuria and urinary tract infection in hospitalized older adults. J Am Osteopath Assoc. 2009; 109:(4)220-226

Gharbi M, Drysdale J, Lishman H Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. BMJ. 2019; 364 https://doi.org/10.1136/bmj.l525

2017; https://bit.ly/3qODbQi

British National Formulary online. 2021; https://bnf.nice.org.uk/

Kalra O, Raizada A Approach to a patient with urosepsis. J Glob Infect Dis. 2009; 1:(1)57-63 https://doi.org/10.4103/0974-777x.52984

Latour K, Plüddemann A, Thompson M Diagnostic technology: alternative sampling methods for collection of urine specimens in older adults. Family Medicine and Community Health. 2013; 1:(2)43-49

Lutters M, Vogt-Ferrier NB Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database Syst Rev. 2008; 3 https://doi.org/10.1002/14651858.cd001535.pub2

MacLullich A, Ryan T, Cash H 4AT rapid clinical test for delirium (version 1.2). 2014; https://www.the4at.com/

Mayne S, Bowden A, Sundvall PD, Gunnarsson R The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing—a systematic literature review. BMC Geriatr. 2019; 19:(1) https://doi.org/10.1186/s12877-019-1049-7

Michels TC, Sands JE Dysuria: evaluation and differential diagnosis in adults. Am Fam Physician. 2015; 92:(9)778-786

Urinary incontinence in neurological disease: assessment and management. Clinical guideline 148. 2012; https://www.nice.org.uk/guidance/cg148/

Urinary tract infections in adults: Quality Standard 90. 2015; https://www.nice.org.uk/guidance/qs90

Sepsis: risk stratification tools. 2017; https://www.nice.org.uk/guidance/ng51/resources/

Urinary tract infection (lower): antimicrobial prescribing. NICE guideline 109. 2018a; https://www.nice.org.uk/guidance/ng109

Pyelonephritis (acute): antimicrobial prescribing. NICE guideline 111. 2018b; https://www.nice.org.uk/guidance/ng111

Urinary tract infection (catheter-associated): antimicrobial prescribing. NICE guideline 113. 2018c; https://www.nice.org.uk/guidance/ng113

Clinical Knowledge Summaries: Urinary tract infection (lower) - women. 2020a; https://cks.nice.org.uk/urinary-tract-infection-lower-women#!topicSummary

Clinical Knowledge Summaries: Pyelonephritis - Acute. 2020b; https://cks.nice.org.uk/pyelonephritis-acute#!topicSummary

Suspected cancer: recognition and referral. NICE guideline 12. 2021; https://www.nice.org.uk/guidance/ng12

Summary of antimicrobial prescribing guidance –managing common infections. 2020; https://bit.ly/2OZ0OrZ

Sepsis guidance implementation advice for adults. 2017; https://www.england.nhs.uk/wp-content/uploads/2017/09/sepsis-guidance-implementation-advice-for-adults.pdf

Point-of-care testing for urinary tract infections. 2016; https://bit.ly/3tmUHwA

Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005; 40:(5)643-654 https://doi.org/org/10.1086/427507

Ninan S, Walton C, Barlow G Investigation of suspected urinary tract infection in older people. BMJ. 2014; 349 https://doi.org/org/10.1136/bmj.g4070

The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018; https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

Perrotta C, Aznar M, Mejia R, Albert X, Ng CW Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008; 2 https://doi.org/10.1002/14651858.cd005131.pub2

Philips H, Huibers L, Holm Hansen E Guidelines adherence to lower urinary tract infection treatment in out-of-hours primary care in European countries. Qual Prim Care. 2014; 22:(4)221-231

Portman DJ, Gass MLS Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Maturitas. 2014; 79:(3)349-354 https://doi.org/10.1016/j.maturitas.2014.07.013

UK Standards for microbiology investigations: investigation of urine. 2019; https://bit.ly/3eDm1ml

English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR): 2019–2020. 2020a; https://bit.ly/30UWNaN

Diagnosis of urinary tract infections: Quick reference tool for primary care for consultation and local adaptation. 2020b; https://bit.ly/3tmXOEV

Annual epidemiological commentary: Gram-negative bacteraemia, MRSA bacteraemia, MSSA bacteraemia and C. difficile infections, up to and including financial year April 2019 to March 2020. 2020c; https://bit.ly/2OR0yLM

30-day all-cause fatality subsequent to MRSA, MSSA and Gram-negative bacteraemia and C. difficile infections, April 2019 to March 2020. 2021; https://bit.ly/3lsvGgE

Rowe TA, Juthani-Mehta M Urinary tract infection in older adults. Aging Health. 2013; 9:(5)519-528 https://doi.org/10.1016/j.idc.2013.10.004

National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS.London: RCP; 2017

Management of suspected bacterial urinary tract infection in adults: a national clinical guideline. 2012; https://bit.ly/3eG6XUV

Risk reduction and management of delirium. SIGN 157. 2019. https://bit.ly/3bPcgQ5

Thornton HV, Hammond A, Hay AD Urosepsis: a growing and preventable problem?. Br J Gen Pract. 2018; 68:(675)493-494 https://doi.org/10.3399/bjgp18x699317

The Sepsis Manual. 2019; https://bit.ly/3rXaimn

Infection Prevention

Urology

Advanced Practice

The management of urinary tract infections in older patients within an urgent care out-of-hours setting

25 March 2021

Focus

02 March 2021

Volume 30 · Issue 6

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.

Urinary tract infections (UTIs) are among the most frequent bacterial infections seen within primary care (National Institute for Health and Care Excellence (NICE), 2020a). They are caused by the presence of multiplying microorganisms in the urinary tract with infection being determined by a combination of bacteria in the urine plus clinical features (NICE, 2015). It is estimated that more than 92 million people are affected worldwide and among older people, UTI is a substantial cause of mortality (NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative, 2016). It is estimated that 1-3% of primary care attendances are due to UTI-related symptoms and they comprise the main reason for 13.7% of antibiotic prescribing (NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative, 2016). The prevalence is approximately 20% in women aged over 65, compared with 11% in the overall population (Chu and Lowder, 2018). However, both genders are at risk of UTI in older age, with a male-to-female ratio of 1:2 (Cove-Smith and Almond, 2007). The risk increases substantially in patients over the age of 85 (Rowe and Juthani-Mehta, 2013).

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Urinary tract infection

UTI

Advanced nurse practitioner

Urgent care out of hours

Prevalence

Management

Older patients