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The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure.

Journal article
Authors Laura W van Buul
Hilde L Vreeken
Suzanne F Bradley
Christopher J Crnich
Paul J Drinka
Suzanne E Geerlings
Robin L P Jump
Lona Mody
Joseph J Mylotte
Mark Loeb
David A Nace
Lindsay E Nicolle
Philip D Sloane
Rhonda L Stuart
Pär-Daniel Sundvall
Peter Ulleryd
Ruth B Veenhuizen
Cees M P M Hertogh
Published in Journal of the American Medical Directors Association
Volume 19
Issue 9
Pages 757-764
ISSN 1538-9375
Publication year 2018
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 757-764
Language en
Subject categories Family Medicine, Geriatrics, Infectious Medicine


Nonspecific signs and symptoms combined with positive urinalysis results frequently trigger antibiotic therapy in frail older adults. However, there is limited evidence about which signs and symptoms indicate urinary tract infection (UTI) in this population. We aimed to find consensus among an international expert panel on which signs and symptoms, commonly attributed to UTI, should and should not lead to antibiotic prescribing in frail older adults, and to integrate these findings into a decision tool for the empiric treatment of suspected UTI in this population.A Delphi consensus procedure.An international panel of practitioners recognized as experts in the field of UTI in frail older patients.In 4 questionnaire rounds, the panel (1) evaluated the likelihood that individual signs and symptoms are caused by UTI, (2) indicated whether they would prescribe antibiotics empirically for combinations of signs and symptoms, and (3) provided feedback on a draft decision tool.Experts agreed that the majority of nonspecific signs and symptoms should be evaluated for other causes instead of being attributed to UTI and that urinalysis should not influence treatment decisions unless both nitrite and leukocyte esterase are negative. These and other findings were incorporated into a decision tool for the empiric treatment for suspected UTI in frail older adults with and without an indwelling urinary catheter.A decision tool for suspected UTI in frail older adults was developed based on consensus among an international expert panel. Studies are needed to evaluate whether this decision tool is effective in reaching its aim: the improvement of diagnostic evaluation and treatment for suspected UTI in frail older adults.

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