Future well-designed studies, using validated criteria for UTI and confusion are required to examine the relationship between UTI and acute confusion in the elderly.

This was often attributable to poor case definitions for UTI or confusion, or inadequate control of confounding factors. ConclusionsĬurrent evidence appears insufficient to accurately determine if UTI and confusion are associated, with estimates varying widely. Only one study had acceptable definitions of confusion and bacteriuria, reporting an association with the relative risk being 1.4 (95% CI 1.0–1.7, p = 0.034). As no study used an acceptable definition of confusion and UTI, an association could not be reliably established. Eight studies defined confusion using valid criteria however, no studies defined UTI in accordance with established criteria. The quality of these included studies varied, with frequent poor case definitions for UTI or confusion contributing to large variation in results and limiting their validity. One thousand seven hunderd two original records were identified, of which 22 were included in the final analysis. Data were extracted using a standardised extraction tool and a qualitative synthesis of evidence was made. Quality assessment was conducted independently by two authors. Inclusion criteria and methods were specified in advance and documented in the protocol, which was published with PROSPERO (registration ID: CRD42015025804). PubMed, Scopus and PsychInfo were searched with the following terms: confusion, delirium, altered mental status, acute confusional state, urinary tract infection, urine infection, urinary infection and bacteriuria. MethodsĪ systematic review of the literature was conducted assessing the association between confusion and UTI in the elderly. This problem is particularly prevalent in nursing home settings. This leads to significant overdiagnosis of UTI, inappropriate antibiotic use and potential harmful outcomes.

Non-specific symptoms, such as confusion, are often suspected to be caused by urinary tract infection (UTI) and continues to be the most common reason for suspecting a UTI despite many other potential causes.

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