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Open Access Highly Accessed Research article

Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes

Pär-Daniel Sundvall123*, Peter Ulleryd4 and Ronny K Gunnarsson23

Author Affiliations

1 Sandared Primary Health Care Centre, Strandvägen 11, 518 32 Sandared, Sweden

2 Research and development unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, 503 38 Borås, Sweden

3 Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, 405 30 Göteborg, Sweden

4 Department of Communicable Disease Control and Prevention, Region Västra Götaland, Institute of Biomedicine, The Sahlgrenska Academy, Kaserntorget 11 B, 411 18 Göteborg, Sweden

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BMC Family Practice 2011, 12:36  doi:10.1186/1471-2296-12-36

Published: 19 May 2011

Abstract

Background

The high prevalence of bacteriuria in elderly individuals makes it difficult to know if a new symptom is related to bacteria in the urine. There are different views concerning this relationship and bacteriuria often leads to antibiotic treatments. The aim of this study was to investigate the relationship between bacteria in the urine and new or increased restlessness, fatigue, confusion, aggressiveness, not being herself/himself, dysuria, urgency and fever in individuals at nursing homes for elderly when statistically considering the high prevalence of asymptomatic bacteriuria in this population.

Methods

In this cross-sectional study symptoms were registered and voided urine specimens were collected for urinary cultures from 651 elderly individuals. Logistic regressions were performed to evaluate the statistical correlation between bacteriuria and presence of a symptom at group level. To estimate the clinical relevance of statistical correlations at group level positive and negative etiological predictive values (EPV) were calculated.

Results

Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself existing at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria.

Conclusions

Urinary cultures provide little or no useful information when evaluating diffuse symptoms among elderly residents of nursing homes. Either common urinary tract pathogens are irrelevant, or urine culture is an inappropriate test.

Keywords:
Urinary Tract Infections; Homes for the Aged; Nursing Homes; Bacteriuria; Predictive Value of Tests