Appendices
24
d
Appendix C: Internal Delphi Consensus Criteria
Decision Tool for the Empiric Treatment of Suspected Urinary Tract
Infection in Frail Older Adults WITH an Indwelling Urinary Catheter
URINARY TRACT
INFECTION SUSPECTED
NO OTHER INFECTIOUS
FOCUS plus AT LEAST
ONE of the following:
• Fever
a
, lasting for ≥24
hours
• Rigors/shaking chills
• Clear-cut delirium
b
, after
excluding urinary retention
as a possible cause
a
Defined as a single oral temperature >37.8°C OR repeated oral temperatures >37.2°C OR rectal
temperature >37.5ºC OR a 1.1°C increase over the baseline temperature.
b
Definition of delirium according to DSM-5: A) Disturbance in attention (i.e., 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, visuospacial 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.
Source: van Buul LW, Vreeken HL, Bradley SF, et al. e development of a decision tool for the
empiric treatment of suspected urinary tract infection in frail older adults: A delphi consensus
procedure. J Am Med Dir Assoc 2018;19:757e764.
PRESCRIBE ANTIBIOTICS
after discontinuation of catheter
and obtaining a urine specimen
for culture. If discontinuation of
catheter is not possible, replace
catheter and obtain a urine specimen
for culture from the new catheter.
Evaluate empiric antibiotic choice
upon availability of culture results.
NO ANTIBIOTICS
Evaluate for other cause and
activiely monitor
c
and reconsider
if new symptoms arise or existing
symptoms do not resolve.
YES
NO
