Time to de-implement urine dipsticks in older adults

We thank Zhang for comments regarding our article.1 Urinary tract infections are overdiagnosed among older adults and judicious antimicrobial use to prevent patient harms and antimicrobial resistance is needed.2We would, however, caution against the idea that the negative predictive value (NPV) of a urine dipstick justifies its widespread use among older adults. Firstly, published performance characteristics are based on urine culture cutoffs of >105. Lower colony counts can cause symptomatic infection and be missed on urine analysis, resulting in a lower NPV.345 Secondly, given the approximately 80-90% prevalence of pyuria among older adults, any impact of the NPV on antimicrobial stewardship is marginal compared with the low value care propagated by its poor positive predictive value.67If better interpretation of urine dipsticks was the solution to overdiagnosis, educational approaches would be adequate. Yet decades of focusing on knowledge gaps without sustained practice change suggests otherwise.8 A positive dipstick in an older…
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