Mass spectrometry identification of true urinary tract infection in elderly women: the SENIOR pilot

In community-dwelling elderly, the incidence of urinary tract infection (UTI) is higher for women than men, and increases significantly with age. Moreover, UTI is the most common infection in Dutch long-term care facilities (LTCF). Due to the high prevalence of asymptomatic bacteriuria (ASB) in elderly women (25-50%), the positive predictive value of pyuria and a positive urine culture is very low. Therefore, current guidelines require the presence of UTI-specific symptoms for antibiotic treatment. However, communication of symptoms may be difficult for elderly patients with cognitive impairment, and many elderly women have preexisting genitourinary symptoms, such as incontinence. A third of LTCF-patients with ASB are treated with antibiotics, contrary to guideline recommendations. Treatment of ASB has no effect on mortality or hospital admissions for UTI, but contributes to antibiotic resistance, drug toxicity and interaction, and carries an eight-fold increased risk of Clostridioides infection.
The primary objective of this proof-of-concept, pilot study is to identify specific urine biomarkers that can discriminate ASB from UTI in women over the age of 65. Our secondary objective is to evaluate whether urine biomarkers can discriminate upper from lower UTI. Seven different urine biomarkers will be quantified using mass spectrometry and ELISA. Patients will be recruited in long term care facilities, general practices and regional hospitals.

We postulate that a specific urine biomarker or biomarker panel can discriminate ASB from UTI

There will only be one time point for patients with upper/lower UTI and patients without UTI. Patients with ASB will be asked to produce a second urine sample four weeks after the first culture, as ASB cannot be determined with one urine culture.

No intervention, only collection of a urine sample