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Low Clinical Significance of Bacteriuria in Institutionalized Elderly With Fever

Background: While urinary tract infection is the most common infection in elderly residents of long-term-care facilities, its contribution to febrile morbidity is not clearly estimated. Therefore, we decided to evaluate the clinical significance of bacteriuria with fever in patients of a long-term-care facility. Methods: All patients with symptomatic urinary tract infection in an 800-bed, multilevel, geriatric, long-term-care facility were enrolled. Urine and blood cultures were obtained from each patient upon enrollment and a urine sample after 3 weeks of a course of antibiotics. Results: Fifty patients were enrolled; in 27 (54%), uropathogen was resistant to antibiotics that had been prescribed. After 3 weeks, no difference in clinical and microbiological outcome was found between patients receiving adequate or inadequate antibiotics. Conclusions: This preliminary study highlights the limitations of clinical and laboratory criteria for diagnosis of symptomatic urinary tract infection and suggests that its contribution to febrile bacteriuria is insignificant, despite the high rate of bacteriuria in long-term-care facilities population.