Bacteriuria and delirium in the elderly

The elderly patient presents “altered.” Urinalysis is abnormal. Evaluation over. Thinking stops.

But there's this from a recent review of the evidence:

..asymptomatic bacteriuria, by which we mean significant bacteriuria without local urinary tract symptoms or evidence of systemic infection, does not cause delirium and should not be treated with antibiotics. Stated differently, delirium is not a symptom of asymptomatic bacteriuria. The widespread belief that asymptomatic bacteriuria causes delirium is harmful. We propose strategies to mitigate this harm until better evidence is developed.

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