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All patients with dysuria have to have a urine taken for chlamydia antigen . It is useful to have a previous urine culture to determine changes in wbc and rbc count per high powered field. Knowing past bacterial sensitivities to the various antibiotics is useful when there recurrent urinary tract infections some experts believe As people age - Dysuria with a high rbc count per high powered field merits the exclusion of bladder cell cancer and other urological malignancy .
An STD is a commonly missed diagnosis that is misdiagnosed as UTI, esp. males under 35. While we typically don't do screening in the ED I agree it is reasonable to do this in young women (but I would recommend NAAT). And hematuria esp in older people should be followed up by a PCP
There may be a problem with the simple statement that UTI does not cause vague and non-specific symptoms in the elderly - confusion, decreased activity, etc. The observation which my mother taught me when she was 90, with the assistance of her PCP, was that the causal role of UTI in such symptoms was confirmed by the prompt resolution of the symptoms with the administration of antibiotics. The PCP's prescription of antibiotics initially also caused severe eye pain in myself when I rolled my eyes in disbelief when she assured me that my mom would improve when the presumed UTI was cleared up. After the second episode, I stopped rolling my eyes, and allowed Mom's PCP to cure her confusion and lethargy by giving her an antibiotic.
This is so challenging! There are multiple studies to suggest that vague symptoms are not due to UTI in the elderly (e.g. altered mental status may be due to delirium from medications or dehydration) but most of these have not been done in the ED. Fever or sepsis a different story. I agree this is why we need better tests to distinguish colonization vs infection-so hard to watch and wait-definitely an area for more study. Thank you for your perspective as a family member. For admitted patients it is also hard to convince the hospitalist not to treat though it might be reasonable to do under observation.
In the recent Urgent Care Rap Procalcitonin was advocated as helpful in this case type - confused elderly people .
To my knowledge PCT has been studied for lower respiratory tract infections and undifferentiated sepsis and has approved indication for those two conditions. While I am aware of several studies attempting to evaluate PCT for UTI or other conditions, at this time there is insufficient evidence to recommend this. I would be interested in the references that would support this use.
Ian L. Despite the confusingly similar name, we are not associated with that publication so we cannot speak to that sorry.
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