Principles of assessment and management of urinary tract infections in older adults

Differentiating between urinary tract infection and asymptomatic bacteriuria can be a challenge in older adults. It can be difficult to identify patients who have atypical symptoms to make a diagnosis of urinary tract infection. In the absence of classic symptoms and positive urine cultures, there is often unnecessary prescription of antibiotic therapy. Asymptomatic bacteriuria can persist in older people and evaluation of other signs and symptoms like abdominal pain and urinary frequency can be difficult in confused or cognitively impaired patients. This review describes the epidemiology and risk factors for urinary tract infection in older adults, the role of urine dipstick testing and urine cultures, the treatment of uncomplicated urinary tract infection, catheter‐associated and complicated urinary tract infections, and antibiotic prophylaxis for recurrent urinary tract infections.