title: Delay in the diagnosis of bacteraemic urinary tract infection in elderly patients.
abstract: Collaboration between clinicians and microbiologists revealed that many patients with subsequently proven urinary tract infection (UTI) present with symptoms suggestive of chest infection. A retrospective analysis was performed on patients over 50 years old with community acquired bacteraemic UTI proven by blood cultures. The main presenting features were confusion (30%), cough (27%), dyspnoea (28%) and new urinary symptoms (20%). The initial clinical diagnosis was UTI in 43% and chest infection in 24%. Chest infection was diagnosed more often in those over 70 years old than those aged 50-70 years old (chi 2 = 7.2, p = 0.007). The majority had pyuria but less than half of the urine samples arrived in the laboratory on the day of admission, fewer from the older patients than the younger (chi 2 = 2.57, p = 0.10). These results demonstrate that UTI frequently presents with respiratory features and that the diagnosis of UTI is often delayed. Sampling the urine with a catheter may be justified to enable diagnosis on the day of admission.
authors.affiliation: Department of Microbiology, United Medical, St Thomas' Hospital, London.
authors.forename: T M
authors.initials: TM
authors.lastname: Barkham
authors.forename: F C
authors.initials: FC
authors.lastname: Martin
authors.forename: S J
authors.initials: SJ
authors.lastname: Eykyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis* / Q000209:etiology; D001437:Bacteriuria / Q000175:diagnosis* / Q000209:etiology; D003371:Cough / Q000209:etiology; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000209:etiology