Table 3 Summary of Studies using Valid Criteria for Confusion
Study | Design of Study | Patient Sample Number, Age, Female %, Catheter % | Care Setting | Association between Confusion and UTI Primary Aim of Study | Confusion Diagnostic Criteria | UTI/Bacteriuria Diagnostic Criteria | Results |
|---|---|---|---|---|---|---|---|
Boockvar et al. 2013 [54] | Cohort; Prospective | 136 patients Age: mean 76 years, SD 12 Female 40% Catheter: Unclear | Nursing Home | Partial | Delirium CAM | Bacteriuria Not Stated UTI Not described | 11 out of 43 (26%) incidents of UTI had delirium |
Collins et al. 2010 [60] | Cross Sectional; Prospective | 710 patients Age: ≥ 70 years; mean 83, range 70–101 Female: 60% Catheter: 5.5% | Hospital (Medical Acute Admissions Unit) | Partially | Delirium CAM | Bacteriuria Not Stated UTI ICD – 10 Codes | 16 out of 110 (15%) patients admitted with delirium had UTI |
Culp et al. 1997 [66] | Cross Sectional; Prospective | 37 residents Age: ≥65 years; Female: Unclear Catheter: Unclear | Long term care facilities (intermediate and skilled bed) | Partially | Delirium screened using NEECHAM and confirmed with CAM | Bacteriuria Not Stated UTI Defined by leukocyturia | 7 out of 15 (47%) patients with delirium had UTI |
Eriksson et al. 2011 [70] | Cross Sectional; Prospective | 504 citizens from population record, Age: 172 aged 85 years, 169 aged 90 years, 63 aged ≥95 years, Female: 100% Catheter: 1.8% | Community Setting (Institutionalised care: 238/504) | Yes | Delirium Organic Brain Syndrome Scale | Bacteriuria Not Stated UTI documented symptomatic UTI, with short- or long-term antibiotics, or symptoms and laboratory tests judged to indicate a UTI | 39 out of 87 (45%) patients with UTI had delirium 39 out of 137 (29%) patients with delirium had UTI UTI was present in 29% of patients with delirium and 13% of those without delirium (p < 0.001) UTI was associated with delirium OR 1.9 (95% CI 1.1–3.3, p = 0.025) |
George et al. 1997 [55] | Case Controlled Prospective | 171 delirious patients Age: ≥65 years mean 81, range 65–98 Female: 54% Catheter: Unclear | Hospital | Partial | Delirium DSM III Criteria | Bacteriuria Not Stated UTI Not Stated | 25 out of 171 (15%) patients with delirium had UTI |
Juthani-Mehta et al. 2009 [3] | Cohort Study Prospective | 551 Residents Age: ≥65 years mean 86, SD 7.1 Female:81% Catheter: 0% | Long Term Care Facilities | Partial | Change in Mental Status Adapted delirium criteria from DSM VI | Bacteriuria ≥104 cfu/ml on urine culture + pyuria (> 10 WBC) on urinalysis UTI Not Stated | 70 out of 147 (48%) patients with bacteriuria + pyuria had mental status changes 70 out of 170 (41%) patients with mental status change had bacteriuria + pyuria Association of mental status change with bacteriuria +pyuria RR 1.4 (95% CI 1.0–1.7, p = 0.034) |
Laurila et al. 2008 [71] | Cohort Study Prospective | 87 patients Age: ≥70 years mean 83.8, range 71–97 Female: 76% Catheter: Unclear | Hospital (Medical Ward) | Partial | Delirium DSM-IV | Bacteriuria Not Stated UTI Consensus of three geriatricians after assessment | 35 of 87 (40%) patients with delirium had UTI |
Marcantonio et al. 2005 [72] | Cohort; Prospective | 188 patients with delirium Age: ≥ 65 years mean 83.3, SD 7.4 Female: 68% Catheter: Unclear | Hospital (Post-acute admissions) | No | Delirium CAM | Bacteriuria Not Stated UTI Clinically documented in the medical record | 22 out of 188 (12%) patients with delirium had UTI 12% of patients with delirium had UTI compared to 7% of patients without delirium (p = 0.22) |