Avoid urine testing for older delirium patients

July 30, 2021

Based on the results of a new high value healthcare study, Johns Hopkins Medicine researchers recommend that doctors avoid routine urine testing of older patients with delirium when there are no clinical signs or symptoms of infection.

The study was published in the Journal of Hospital Medicine.

Study lead author Milad Memari, MD, Senior Resident in Internal Medicine at the Johns Hopkins University School of Medicine. “Our research indicates that patients, who are elderly, delirious and unable to give their medical history, may be more likely to suffer from the consequences of unnecessary testing and treatment. Urine tests are often one of the first that doctors call for in these situations.”

In their research, researchers reviewed previous studies by others that evaluated the practice of conducting urine tests in hospitals, specifically those for older people with delirium. From one of these studies, the team learned that 83% of nearly 3,000 patients in hospitals across the nation — including patients 65 years of age and older — were given antibiotic therapy based on urine cultures positive for bacteria even though the microbes may in fact be harmless. Another investigation showed that more than a quarter (92 out of 343 patients, or 27%) received antibiotics when they did not have clinical signs of urinary tract infections, and they had suffered from harmful long-term consequences of these treatments that may have been unnecessary.

Memari said that a large number of older patients may not have urinary infections, even though their urine cultures test positive for bacteria. The focus, he says, should be avoiding unnecessary testing to prevent treatment of bacteria that are a normal, healthy part of a patient’s urinary ecosystem. Also, the more a patient is treated for a urinary infection, the more likely that person will develop a resistance to antibiotics.

In turn, Memari says, this makes urinary infections harder to treat in future instances and has contributed to the public health issue of increased antibiotic resistance in a highly vulnerable population.

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