Choosing Wisely UTI

Mom is in the nursing home with Alzheimer’s, and has repeated urinary tract infections (UTI) treated with antibiotics whenever she becomes more confused.  We’re now told these likely weren’t infections and the antibiotics should be avoided.  How will we know if she has an infection and when it should be treated?


To improve quality of care, doctors initiated the Choosing Wisely campaign in 2013, which publicizes tests and procedures found to be more often harmful, and helps seniors avoid these.

The American Geriatrics Society (AGS) and the American Medical Directors Association (AMDA), recommend that when considering if a senior has a UTI, Don’t use antibiotics just because bacteria are found in the urine, unless specific urinary symptoms are also present.

Studies confirm that for seniors to have a treatable UTI, they must have urine-related symptoms, such as burning when passing urine, going more often with new incontinence, a fever, low abdominal pains.  Without these symptoms, no harm is done if they do not receive antibiotics just because their urine has bacteria. 

Dementia patients have been assumed to have a UTI when there’s an increase in confusion.  We now know most seniors in nursing homes always have bacteria in their urine (they are ‘carriers’); assuming there was an infection stopped us looking for other causes of their new confusion.

In addition, the AGS and AMDA recommend the only way to test urine for this is to use a catheter:   “clean-catch” specimens [peeing into a cup] are always contaminated and can be falsely positive. 

Thus, the evidence is clear:  do only tests/procedures shown to be beneficial, and avoid unnecessary drugs.  If your mom is more confused but has no fever, no urine-specific symptoms, then don’t do a urine test; rather, look for other possible causes of confusion [drugs, irritating people/relatives!].