HealthDay News — Constitutional symptoms, including mentation, often lead to diagnostic testing and potentially inappropriate antibiotic prescribing in older patients suspected of having a urinary tract infection (UTI) or pneumonia, according to a study published online September 22 in the Journal of the American Geriatrics Society.

Angela C. Eke-Usim, MD, MPH, from the University of Michigan in Ann Arbor, and colleagues examined the use of diagnostic testing before treating an infection in nursing home (NH) residents suspected of having UTI or pneumonia. Data were included for 162 NH residents with an indwelling urinary catheter, enteral feeding tube, or both. There were 695 follow-up visits, including 28% with an infection. 

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The researchers found that 100 NH residents (62%) had an incident infection necessitating antibiotic treatment, with considerable variation between NHs. Change in function significantly predicted ordering a chest X-ray to detect pneumonia (odds ratio, 1.7), as well as the presence of infection-specific symptoms. Change in mentation significantly predicted ordering a urinalysis, chest X-ray, and blood culture (odds ratios, 1.9, 3.3, and 2.3, respectively). In 21.5% of 233 suspected UTI cases and 30.2% of 53 suspected pneumonia cases, antibiotics were used empirically, before laboratory results were available. In 17% of visits without documented clinical or laboratory evidence of infection, antibiotics were used.

“Antibiotic use often continues despite negative test results and should be a target for future interventions,” the authors write.

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