Testing The Waters: Is Urinalysis Overused In Older Patients?

Abstract Background Diagnosing urinary tract infections (UTIs) in older adults can be challenging with frequent non-specific presentations and a high prevalence of asymptomatic bacteruria. Over-reliance on dipstick urinalysis and indiscriminate ordering of urine cultures leads to inappropriate diagnoses and unnecessary antibiotic use. In 2021, the HSE issued a position statement endorsed by the National Antimicrobial Stewardship Advisory Group that, in those over 65, the use of dipstick urinalysis in assessing for evidence of a UTI is not useful and is not recommended. Methods The aim of this project was to determine if urinalysis is conducted in those over 65 years old to assess UTI in contradiction to the HSE statement. A retrospective chart review was conducted assessing charts of 115 adults aged over 65 who had a urine culture ordered. Clinical features, laboratory data, and antibiotic prescribing were assessed. The appropriateness of urine testing was benchmarked against the HSE position statement. Diagnoses were evaluated using McGeer criteria. Statistical analysis examined associations between patient factors, urine testing, and UTI diagnoses. Results Dipstick urinalysis was performed in 73% of cases, contrary to the HSE position. There was no specific patient factor associated with urinalysis being performed, suggesting it is routine practice. Performing a dipstick urinalysis was associated with getting a UTI clinical label (p=0.009). However, 29.2% of diagnosed UTIs did not meet diagnostic criteria. Urine cultures were ordered in 12.1% without any clinical indication. Only 14.8% of patients met criteria for a symptomatic UTI. Many patients were treated for UTIs with insufficient evidence to support the diagnosis. Conclusion Urine dipsticks and cultures are frequently used inappropriately in adults over 65, contributing to over-diagnosis and over-treatment of UTIs. This has implications for antimicrobial stewardship and resource use. Interventions focused on education and adherence to existing guidelines may reduce inappropriate testing and improve diagnostic accuracy in this population.