Loeb minimum criteria for diagnosis of urinary tract infection (UTI) in a resident of long term care facility (residential home)

Last edited 09/2023 and last reviewed 11/2023

Loeb minimum criteria for diagnosis of urinary tract infection (UTI) in a resident of long term care (residential home)

Loeb et al used expert opinion to develop criteria for initiating antibiotics in long term care facilities (LTCFs)

Catterino et al note:

• issues also complicate the study of infections in older adults
  • diagnostic criteria that rely on presence of symptoms and/or culture results may not be accurate in a population where symptoms are often absent and colonizing microorganisms often present
    • for example, the high prevalence of asymptomatic bacteriuria in older adults means that relying solely on urine cultures overestimates acute UTIs
    • also note that 50% of older adults with bacteremic UTI, a clear case of true acute infection, lack urinary symptoms

• Acute dysuria

• or

• Fever (>37.9°C or 1.5°C increase above baseline temperature) AND at least one of the following: new or worsening urgency, frequency, suprapubic pain, gross haematuria, costovertebral angle tenderness, or urinary incontinence

Reference:

• Caterino JM, Leininger R, Kline DM, Southerland LT, Khaliqdina S, Baugh CW, Pallin DJ, Stevenson KB. Accuracy of Current Diagnostic Criteria for Acute Bacterial Infection in Older Adults in the Emergency Department. J Am Geriatr Soc. 2017 Aug;65(8):1802-1809.
• Piggott K L, Trimble J, Leis J A. Reducing unnecessary urine culture testing in residents of long term care facilities BMJ 2023; 382 :e075566 doi:10.1136/bmj-2023-075566