Table 1.
Categories of Information Used in UTI Decision-Making Survey
| Category | Information | Evidence-Based Criteria? |
|---|---|---|
| Lower Urinary Tract Signs or Symptoms | • No lower urinary tract signs or symptoms | |
| • Painful or difficult urination | Yes3,32,35,37 | |
| • Obvious blood in urine | Yes32,34 | |
| • Change in urine clarity or odor | No34 | |
| • New or worsening frequency | Yes34–37 | |
| Body Temperature | • Temperature is 97.5°F | |
| • Temperature is 101.5°F | Yes3,32,35–37 | |
| • Temperature is 99.5°F | Yes3,32,44 | |
| • Temperature is 96.5°F | No | |
| Urinalysis | • Negative leukocyte esterase, negative nitrates, urine results pending | Rule out |
| • Positive leukocyte esterase, positive nitrates, urine results pending | Yes32 | |
| • Positive leukocyte esterase, negative nitrates, urine results pending | No | |
| • Unavailable/Not performed | No | |
| UTI Risk | • No history of UTIs or current indwelling catheters | |
| • Current indwelling catheter and history of three UTIs over the past year | Equivocal52 | |
| • History of three UTIs over past year but no current indwelling catheter | No | |
| • Current indwelling catheter but no history of prior UTIs over past year | Equivocal52 | |
| Physical Examination | • Normal physical exam | |
| • New suprapubic tenderness or costovertebral angle tenderness | Yes3,34–37 | |
| • New or increased area of redness and warmth on left lower leg | No53 | |
| • New or increased cough and work of breathing | No53 | |
| Mental Status | • Usual state of health | |
| • New or worsening confusion | Yes35–37 | |
| • New or worsening agitation | Yes35–37 | |
| • Sleeping more than usual | No3 | |
| Antimicrobial Request | • No antimicrobial request from either patient, family, or nurse | |
| • Antimicrobial request from family | No23,54–58 | |
| • Antimicrobial request from resident | No23,54–58 | |
| Functional Status | • Usual state of health | |
| • New or increase falls | No3 | |
| • New or increased resistance to care | No | |
| • New or worsening difficulties with ambulation or transfers | No3 | |
| • Reduced intake of food and liquids | No3 | |
| Goals of Care | • Comfort care measures | |
| • Full scope of treatment | No | |
| • Limited additional interventions | No | |
| Patient Type | • 84 year-old cognitively-intact man | |
| • 84 year-old cognitively-intact woman | Equivocal59 | |
| • 84 year-old man with dementia | Equivocal24,60,61 | |
| • 84 year-old woman with dementia | Equivocal24,59–61 | |
Note. Evidence-based information is bolded and citations are provided. No = Non-evidence-based criteria, equivocal response means evidence is mixed. The reference group for each category is italicized. The following categories of information were considered as evidence: level A (controlled trials), level B (comparative studies) and level C (expert opinion); both nursing home specific studies and studies about older persons in general were considered relevant.