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Managing UTIs in Older Women

Managing UTIs in Older Women

Recent estimates show that urinary tract infections (UTIs) are among the most common bacterial infections occurring in the United States. There are more than 8 million annual office visits and 1 million ED visits for UTIs annually, with about 100,000 cases resulting in hospitalizations. “UTIs are twice as common among women of all ages when compared with men,” says Lona Mody, MD, MSc. “Asymptomatic bacteriuria, urinary incontinence, and symptomatic UTIs are especially prevalent in older women, but it can be difficult for clinicians to identify which patients warrant antibiotic therapy.” In an issue of JAMA, Dr. Mody and Manisha Juthani-Mehta, MD, had a clinical review published in which the authors looked at the management of asymptomatic bacteriuria and symptomatic UTIs among older community-dwelling women. The spectrum of urinary conditions can range from asymptomatic bacteriuria to symptomatic UTIs or worse (Table 1). “Many symptoms of UTIs mimic other problems that can affect older women,” explains Dr. Mody. “This can make it challenging for clinicians to know when and how to treat patients.” Making a Diagnosis The review article by Dr. Mody and Dr. Juthani-Mehta notes that asymptomatic bacteriuria is generally benign in older women. However, the diagnosis of a symptomatic UTI can be more challenging when considered in the context of chronic genitourinary symptoms, increasing cognitive impairment, and comorbidities from advancing age. When evaluating new dysuria, several factors are important, including timing, severity, and location. Worsening urinary frequency or urgency can occur for both UTIs and in urinary incontinence, making these symptoms unreliable indicators for UTIs. Conversely, new dysuria is more specific for symptomatic UTIs. If this is present, there...
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