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Abstract
Asymptomatic bacteriuria is common in the elderly, occurring in as many as 25-50%
of elderly nursing home residents. Asymptomatic bacteriuria itself should not be treated
with antimicrobial therapy. Difficulties in communication, chronic genitourinary symptoms,
and the high frequency of positive urine cultures, make ascertainment of symptomatic
infection problematic for the functionally impaired elderly. Chronic genitourinary
symptoms are not a manifestation of acute urinary infection, although acute deterioration
in symptoms may be consistent with infection. Fever in an institutionalized elderly
subject with a positive urine culture and without an indwelling catheter is due to
urinary infection in less than 10% of episodes. However, there are no criteria to
differentiate urinary infection from other sites in this clinical scenario. Thus,
neither urine culture nor clinical presentation allows a diagnosis of symptomatic
urinary infection to be made with a high level of certainty. Decisions with respect
to antimicrobial therapy must be made on an individual basis and with an understanding
of these diagnostic limitations. It is not realistic to expect to optimize antimicrobial
usage in this population until issues of diagnostic uncertainty are addressed.