Urine testing in elderly people—what about the negative predictive value?

Piggott and colleagues raise a valid point about high asymptomatic bacteriuria rates in elderly people being mistaken for active urinary tract infections (UTIs).1 Over-prescription of antibiotics incurs significant morbidity to the patient (side effects and Clostridium difficile risk in vulnerable cohorts) and the wider population (antimicrobial resistance and wasted resources). It is often clinical interpretation of results that is flawed, however, rather than the tests themselves, and we should not abandon them.These tests have poor positive predictive value and should not be used in isolation to diagnose UTI in elderly people. There is no meaningful discussion in the article of the importance of the high negative predictive value of urine dipsticks, frequently quoted as being greater than 95%.23 No white cells or bacterial growth on culture is also telling. For unwell elderly patients lacking specific symptoms, I welcome the extra information that these simple urine tests provide. If negative, I…
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