DELAY IN THE DIAGNOSIS OF BACTEREMIC URINARY-TRACT INFECTION IN ELDERLY PATIENTS

Collaboration between clinicians and microbiologists revealed that man y patients with subsequently proven urinary tract infection (UTI) pres ent with symptoms suggestive of chest infection. A retrospective analy sis was performed on patients over 50 years old with community acquire d bacteraemic UTI proven by blood cultures. The main presenting featur es were confusion (30%), cough (27%), dyspnoea (28%) and new urinary s ymptoms (20%). The initial clinical diagnosis was UTI in 43% and chest infection in 24%. Chest infection was diagnosed more often in those o ver 70 years old than those aged 50-70 pears 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 olde r patients than the younger (chi(2) = 2.57, p = 0.10). These results d emonstrate 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.