• Zvi Shimoni, Amrani Kasem, and Paul Froom.
• Department of Internal Medicine B, Sanz Medical Center, Israel and Ruth and Bruce Rappaport School of Medicine, Netanya, Haifa, Israel.
• Int. J. Clin. Pract. 2021 Apr 1; 75 (4): e13741.

AimIn elderly patients with a urinary tract infection, the influence of mental status on the frequency of local urinary tract symptoms is uncertain. We aim to compare the frequency of reported local urinary tract symptoms between mentally intact and cognitively impaired older people with a bacteraemic urinary tract infection.MethodsWe retrospectively selected consecutive patients aged 65 years or older hospitalised in internal medicine departments in a regional hospital from 1 January 2015 to 31 December 2016 if they had identical bacteria isolated from blood and urine cultures. Mentally intact patients were those who were alert on admission and throughout their hospitalisation and without a prior or new diagnosis of dementia.ResultsOf 222 patients with a bacteraemic urinary tract infection, 125 (56.3%) did not have local urinary tract symptoms, 68.8% (86/125, 95% CI-60.7%-76.9%) cognitively impaired, compared with 40.2% (39/97, 95% CI-30.4%-50.7%) in those mentally intact (P < .001).ConclusionsThe absence of local urinary tract symptoms in elderly patients with a bacteraemic urinary tract infection is less frequent but common in those mentally intact, and should not preclude the need for a urine culture or antibiotic therapy.© 2020 John Wiley & Sons Ltd.

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