Appendices
22
d
URINARY TRACT
INFECTION SUSPECTED
a
Presence of at least fever (i.e., a single oral temperature >37.8°C OR repeated oral temperatures
>37.2°C OR rectal temperature >37.5°C OR a 1.1°C increase over the baseline temperature), rigors/
shaking chills and/or clear-cut delirium.
b
Definition of delirium according to DSM-5: A) Disturbance in attention (i.e., a reduced ability to
direct, focus, sustain and shi attention) and awareness (reduced orientation to the environment).
B) e disturbance develops over a short period of time (usually hours to a few days), represents an
acute change from baseline attention and awareness, and tends to fluctuate in severity during the
course of a day. C) An additional disturbance in cognition (e.g., memory deficit, disorientation,
language, visuospatial ability or perception.) D) e disturbances in Criteria A and C are not better
explained by a pre-existing, established or evolving neurocognitive disorder and do not occur in the
context of a severely reduced level of arousal such as coma. E) ere is evidence from the history,
physical examination or laboratory findings that the disturbance is a direct physiological consequence
of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a
medication), or exposure to a toxin, or is due to multiple etiologies.
c
E.g., monitoring vital signs, paying attention to hydration status and repeated physical assessments by
nursing home staff.
Systemic sign(s)/
symptoms(s)
a
?
≥2 of the aforementioned
localizing signs/symptoms OR 1
very bothersome localizing sign/
symptom with no other cause
YES
Appendix C: Internal Delphi Consensus Criteria
Decision Tool For The Empiric Treatment of Suspected Urinary Tract
Infection in Frail Older Adults WITHOUT an Indwelling Urinary Catheter
Costovertebral angle pain/
tenderness OF RECENT
ONSET?
Systemic sign(s)/
symptoms(s)
a
?
ONE OR MORE of the following signs & symptoms (alphabetic order),
REGARDLESS OF URINALYSIS RESULTS:
Agitation/aggression (new/worsening), cloudy urine, decreased dietary
intake, decreased fluid intake, decreased functional status/ADL, decreased
motility, decreased urinary output, diarrhea, dizziness (new/worsening),
fatigue (new/worsening), general lack of well-being, macroscopic
hematuria, (regardless of oral anti-coagulant use), malaise, mental status
change without a clinical suspicion of delirium,
b
nausea (with or without
vomiting), nocturia, prostate pain, scrotum pain, suprapubic pain, syncope,
urinary retention change in urine color, change in urine odor, weakness
(new/worsening)
YES
YES
NO
NO
NO
YES
YES
YES
NO
NO
RECENT ONSET OF
dysuria, urgency, frequency,
incontinence, (visible)
urethral purulence?
