Letters Delirium in older adults

Authors’ reply to Ninan

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3063 (Published 15 May 2013) Cite this as: BMJ 2013;346:f3063
  1. Edison I O Vidal, assistant professor1,
  2. Fernanda B Fukushima, assistant professor2,
  3. Adriana P Valle, associate professor1,
  4. Ana Teresa A R Cerqueira, associate professor3,
  5. Paulo J F Villas Boas, associate professor1
  1. 1Internal Medicine Department, Universidade Estadual Paulista (UNESP), 18618-970 , Botucatu, SP, Brazil
  2. 2Anesthesiology Department, Universidade Estadual Paulista (UNESP), 18618-970, Botucatu, SP, Brazil
  3. 3Neurology, Psychiatric and Psychology Department, Universidade Estadual Paulista (UNESP), 18618-970, Botucatu, SP, Brazil
  1. eiovidal{at}fmb.unesp.br

We agree with Ninan that urinary tract infections (UTIs) are often overdiagnosed in older people and that too often asymptomatic bacteriuria is treated with antibiotics.1 However, correctly diagnosing UTI in older patients with delirium is more challenging than it may seem, and diagnosing UTI exclusively on the basis of the presence of acute urinary symptoms or bacteriuria accompanied by fever or inflammatory markers would be equally flawed.2 For example, in the study cited by Ninan, only 45% of the patients classified as having a bacteraemic UTI had any urinary tract symptoms.3 Moreover, in that study patients with delirium with evidence of a septic illness in the absence of a more likely source (such as pneumonia), and without a negative urine culture, were classified as having presumed UTI.4


Cite this as: BMJ 2013;346:f3063


  • Competing interests: None declared.