UTI: confusion drives excessive antibiotic prescribing for the elderly

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  • Higher prevalence of new or worsening confusion in nursing home (NH) residents drove significantly higher urinary tract infection (UTI) antibiotic use within past month (P<.001).
  • No differences were observed in documented UTI or symptomatology in this patient population vs individuals residing in nontropical environment.

Why this matters

  • Asymptomatic bacteriuria in NH residents may accompany an array of nonspecific symptoms, leading to overprescribing of antibiotics without established UTI diagnosis.
  • A high prevalence of confusion in NH residents should not be the primary driver of a clinical strategy; prudent use of narrow- vs broad-spectrum agents is recommended.

Key results

  • 450 NH residents were included; 3% (n=13) had a documented current UTI and 9% (n=40) had a UTI within the last 30 days.
  • UTI accounted for 33% of current infections and 40% of all infections within the last 30 days.
  • Over the course of 30 days, 20% NH residents had received antibiotics (45% for suspected UTI).
  • Factors significantly associated with UTI antibiotics 30 days included catheterization (OR, 13; 95% CI, 2.4-67; P=.003).

Study design

  • Cross-sectional, observational study quantifying prevalence of documented UTI, nonspecific symptoms, and antibiotic treatment in Australian NH residents.
  • Funding: James Cook University, Australia.


  • Reliance on chart reviews.
  • Target sample size not achieved.