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The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - A systematic literature review

Review article
Authors Sean. Mayne
Alexander. Bowden
Pär-Daniel Sundvall
Ronny K Gunnarsson
Published in BMC Geriatrics
Volume 19
Pages 1-15
Publication year 2019
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 1-15
Language en
Subject categories Family Medicine, Infectious Medicine, Geriatrics


Context: Non-specific symptoms in elderly patients such as confusion is often suspected to be caused by a urinary tract infection (UTI) and it continues to be the most common reason for suspecting a UTI despite many other plausible causes. This leads to significant over diagnosis of UTI, increased inappropriate antibiotic use and potentially harmful outcomes through misdiagnosis. This problem is particularly prevalent in nursing homes settings. Objective: Clarify the correlation between lower UTI or bacteriuria and concurrent confusion. Setting: Any care setting for elderly (hospital, community and long term care facility). Design: A systematic literature review Main And Secondary Outcome Measures: A review of the literature was conducted assessing the association between confusion and UTI in the elderly. PubMed, Scopus and PsychInfo were searched with the following terms: confusion, delirium, altered mental status, acute confusional state, urinary tract infection, urine infection, urinary infection and bacteriuria. Inclusion criteria and methods were specified in advance and documented in the protocol, which was published with PROSPERO (registration ID CRD42015025804). Quality assessment was conducted independently by two authors. Data was extracted using a standardised extraction tool and a qualitative synthesis of evidence was made. Results: 1702 original records were identified of which 22 were included in the final analysis. Following this review, it appears that insufficient evidence is available to accurately determine if UTI and confusion are associated. Conclusion: The potential link between UTI and non-specific symptoms in elderly patients remain confusing. More epidemiological studies are unlikely to resolve this problem. The next logical step to clarify this issue should be a randomized controlled trial comparing the effect of antibiotics versus placebo using validated criteria for both UTI and confusion.

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