The role of Dutch guidelines in the diagnostic outcomes and treatment decisions of hospitalised older adults with a suspected urinary tract infection: a retrospective cohort study

Purpose Urinary tract infections (UTIs) are highly prevalent and difficult to diagnose in older adults. We aimed to evaluate the applicability of Dutch Association of Urology (NVU) and Dutch Association of Elderly Care Physicians (Verenso) guidelines in terms of diagnostic outcomes and treatment decisions in hospitalised older adults with suspected UTIs. Methods A retrospective cohort study was conducted on 225 geriatric patients with a urine culture taken in 2019, to determine conformity of the studied population to NVU and Verenso. Results Of 225 patients with suspected UTI (mean age 86 years; 56.4% female), 67.6% had urinary tract-related symptoms, of whom 96 received antibiotics, including those with a negative urine dipstick (n = 12) or urine culture (n = 28). Hundred seventy-seven and 147 patients were assessed and treated conforming to the NVU and Verenso guidelines, respectively. The 38 patients who were assessed and treated non-conforming to NVU, including patients with negative urine diagnostics, received antibiotics more often compared with 177 patients treated conforming to NVU (p < 0.001). A large number of patients with negative urine tests were treated conforming to Verenso and antibiotics were withheld in 75.5% of the patients. The non-conforming Verenso-treated patients with prescribed antibiotics had significantly more negative dipstick results (p = 0.05), fewer urinary tract-related symptoms (p < 0.001) and more often a different infectious focus (p < 0.001). Conclusion The common practice performed on the studied geriatric population was more in accordance with the NVU guideline than Verenso. The results indicated that compliance with the guidelines might lead to fewer antibiotic prescriptions in the study population. Key summary pointsAim To evaluate the applicability of the urinary tract infection (UTI) diagnostic and treatment guidelines of the Dutch Association of Urology (NVU) and Dutch Association of Elderly Care Physicians (Verenso) in hospitalised older adults with suspected UTI in terms of diagnostic outcomes and treatment decisions. Findings Adherence to either the NVU or the Verenso guidelines suggested that fewer antibiotics would have been prescribed in our study population. However, implementing the Verenso guideline in hospitals would demand a shift from diagnostic testing to focusing on urinary tract-related symptoms. Message Compliance with the NVU or the Verenso guidelines may have resulted in fewer antibiotic prescriptions in the study population.