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An 83-year-old male with a long term catheter is admitted to hospital with fever, delirium with an AMTS of 5 (He knows the month, the year, the PM and monarch and WW2) and loin and suprapubic discomfort. He has a clinical frailty score of 6. He lives at home with his wife and he has carers twice a day. The WCC is 15 and CRP is 67. His urine is concentrated. Clinically he is dry. His CXR is clear and there are no respiratory symptoms.
Answer
1. What test result would you like and how would you treat
What is the correct management
Do all patients with this condition need admission or hospital referral
4. How useful is urine dip in asymptomatic patients with a catheter
5. What other patients may need hospital referral
6. What other antibiotics may be used here
7. Question
8. Question
9. Question
10. Question
References
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Case #14 Confusion
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The clinical picture fits with an upper urinary tract infection.
A catheter sample of urine shows protein ++, Leucocytes ++ and nitrites++. You send a sample for culture.
Refer people with catheter-associated UTI to the hospital if they have a severe systemic infection (any of the high-risk criteria from the NICE guideline on sepsis).
Generally unhelpful. The only time that it might be useful is in pregnant patients. In older patients with catheters, the dipstick can appear positive but treatment only advised when there are symptoms or signs of UTI.
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