The 2019 IDSA guidelines removed delirium as a reason to call bacteriuria "symptomatic"
Watchful waiting and investigating other causes is now a strong recommendation for delirious elderly with bacteriuria without urinary symptoms such as frequency, urgency, burning or supra-pubic discomfort
Watchful waiting is also recommended in elderly patients who experience a fall, regardless of mental status change
Delirium in the elderly should be worked up for:
- new medication side-effects or interactions
- other infections
Antibiotic therapy in such cases has no benefit and is associated with harm such as antibiotic resistance and C. difficile infection
Sending urine for urinalysis and culture in otherwise asymptomatic individuals who are functionally impaired or residing in long-term care is no longer recommended
Many elderly with delirium have bacteriuria or pyuria. Urine should not be sent for urinalysis or cultures due to a cloudy appearance or foul smell.