title: Urine Cultures in Hospitalized Geriatric Patients Presenting With Fever.
abstract: BACKGROUND
  Urine cultures are commonly ordered in geriatric patients presenting with fever in the emergency department, but it is unclear if indiscriminate urine culture testing is warranted.
  
  
  METHODS
  We selected 708 consecutive geriatric patients with a chief complaint of fever to determine the clinical usage (changes in antibiotic therapy according to culture results) and the costs of culturing the urine that included the need for catheterization to obtain a sample for culture and complications from catheterization. We divided the patients into those with and without an extraurinary tract source for fever on admission.
  
  
  RESULTS
  Urine cultures were performed in 74.9% (233/312) of the patients with a source for the fever outside the urinary tract and required urinary catheterization to obtain a sample in 36.8% (95/233) of those patients. Cultures were positive for bacteria 29.6% of the time (69/233), but did not result in the change of antibiotic treatment in any of the patients. Urine cultures were performed in 92.6% (326/352) of the patients without an extraurinary tract source for the fever, required catheterization in 49.7% (162/326) of the patients and 58.3% (190/326) of the cultures were positive for bacteria. Urine culture sensitivities changed antibiotic therapy in 24.2% (46/190) of the patients. There were no patients in either group with complications from urinary catheterization, but indwelling catheter rates increased inappropriately in both the groups.
  
  
  CONCLUSIONS
  We conclude that urine culture testing is unnecessary in hospitalized geriatric patients who on admission have an extraurinary tract source for their fever, but it has clinical usage when the source for the fever on admission is unclear.
authors.affiliation: Internal Medicine Department B, Laniado Hospital, Netanya, Israel; Technion Ruth and Bruce Rappaport School of Medicine, Haifa, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Shimoni
authors.affiliation: Internal Medicine Department B, Laniado Hospital, Netanya, Israel.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Avdiaev
authors.affiliation: Department of Clinical Utility, Laniado Hospital, Netanya, Israel; School of Public Health, University of Tel Aviv, Tel Aviv, Israel. Electronic address: froomp@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Froom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000652:urine; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000652:urine*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018805:Sepsis / Q000188:drug therapy / Q000652:urine*; D016482:Urinalysis; D014546:Urinary Catheterization
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clinical usage; Fever; Geriatric patients; Urine culture