Myths and MSUs

Urinary tract infections (UTIs) are common in the elderly. They are also commonly overtreated. This can result in adverse reactions to medication including side effects like upset stomach or diarrhea, interactions with other drugs like coumadin (a blood thinner), or allergic reactions. There is also the potential loss of normal flora (good bacteria in our body) leading to overgrowth of C. difficile (bad gut bacteria) or Candida spp. (yeast) and development of antibiotic resistant organisms (AROs). Assuming someone has a UTI when they don't might also mean missing the real diagnosis.

This issue is unsurprisingly #1 on the Canadian Geriatric Society's Choosing Wisely hitlist: "Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present."

The Association for Elderly Medicine Education (AEME) has released a handful of excellent Mini-GEMs (Geriatrics E-learning Modules) on their youtube channel. This one, on "Myths and MSUs", where MSU = mid-stream urine test, was recently brought to my attention. It's aimed at physicians, but the take away for patients would be to ask "I feel fine and don't have any symptoms - do I really need an antibiotic for my bladder?"

I think it's a really clear walk-through of how to manage bladder infections, with a view to understand colonization (bacteria hanging out in the bladder that isn't causing harm) and interpreting the dip-stick test so as to avoid overtreatment. It's also a good reminder that, although common, a UTI is not always the cause of delirium, a temporary state of confusion secondary to underlying illness usually in the elderly.

Here's the video:

This MiniGEM explains how and when to diagnose UTI in older patients, and common pitfalls to avoid!