A nursing home resident in her 80s has a history of falls, cognitive impairment, and incontinence. In the past 2 years, she was thought to have a urinary tract infection (UTI) on 8 occasions and received antibiotic therapy 6 times. Symptoms that triggered an evaluation for UTI included increased confusion, urinary frequency, cloudy urine, lethargy, hallucinations, and falls. On this occasion, the family reports that she “doesn’t look right,” but the nursing staff states she is not confused. The patient reports no dysuria or abdominal pain but does chronically complain of voiding frequently. She is afebrile with no abdominal, suprapubic, or flank tenderness, but her urine has a foul odor. A catheterized urine specimen is obtained and results of urinalysis are reported (Table). The urine culture reveals more than 100 000 colony-forming units (CFUs) per milliliter of Escherichia coli, which is sensitive to all antibiotics except ampicillin.
Juthani-Mehta M, Datunashvili A, Tinetti M. Tests for Urinary Tract Infection in Nursing Home Residents. JAMA. 2014;312(16):1687-1688. doi:10.1001/jama.2014.13554