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Table 3 Summary of Studies using Valid Criteria for Confusion

From: The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review

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)