UTI – Urinary Tract Infection.

UTI has become part of everyday language. A meme that represents our changing society.

Twenty years ago, when I was at medical school UTIs existed, they were however still within the rarefied toolkit of doctors.

UTIs have grown and changed, morphed from something specialised, something that you needed a medical degree to diagnose, into a 21st Century commodity like Vapes or cans of Red Bull.

It is not uncommon for a relative to tell me that they think their mum or dad has a UTI.

‘They always behave like this when they have a UTI,’ or, ‘It’s a UTI – you can smell it a mile-off,’ and, words to this effect.

Relatives and carers aren’t to blame for this quick-fix, quick-fire method of diagnosis as the whole health and social care economy has jumped-on the bandwagon of UTIs, not as a panacea, but as an explanation for most that goes wrong with older people – falls, confusion, pain, immobility, fever, non-specific blood-test anomalies; you name it and it can be caused by a UTI.

Or not.

You see, when a scientific approach is taken and the situation analysed, we discover that there is more in the world of frailty and ageing than urine infections.

In reality, UTIs are actually more complicated than an older person smelling of pee.

Smell is not a UTI. Smell is just the smell of pee.

Falls. Older people fall. They also on occasion become confused; this is delirium – a reversible condition akin to dementia which is irreversible and, which can also be experienced by people with or without UTIs.

As we age, our microbiome evolves; the bugs living on our skin, in our bowel and bladder alter. Urine is meant to be sterile, although often, in older people, bacteria get in, but, instead of pathogens causing disease, are either commensals – living in harmony or, tourists in your urethra.

These aren’t UTIs; for this purpose, we invented Asymptomatic Bacteriuria.

Treating asymptomatic bacteriuria is a little like the tactics used by Texas police; Hands in the air. You look iffy… I’m taking you down the station.

Time has fuelled the growth in UTIs in A&E and, in 21st Century Healthcare in general. The numbers of people, seeking assessment, diagnosis and treatment, all, squeezed into a limited window of opportunity encourage quick fixes; botched jobs that take you nowhere;

This is the prescription for Trimethoprim, when, a person is lonely.

It doesn’t work.

Or, when an old woman is poisoned by other drugs prescribed decades before to treat real conditions and which are no longer a risk – statins, pain-killers and blood pressure treatments; the answer, another drug that isn’t needed and compounds the insult.

‘It’s a UTI,’ doctors and nurses become complicit in the scam. Often this is given as a diagnosis when nothing else fits, or, when what fits is not congruent with what is apparent. And then, with more time, more reflection and analysis the diagnosis is undone – de-diagnosed and the medicine de-prescribed, we find ourselves untangling the knot.

The overuse of antibiotics globally is considered by some, to be as great a threat as global warming, international terrorism or avian flu. These are boogeymen that capture the headlines.

Nitrofurantoin – how can that harm you; go on, just a little prescription, just a few tablets;

My request? Well, that is to slow down.

Think UTI by all means, but don’t allow it to overwhelm the senses.

Think linear.

In most instances it is straightforward, and here is the trick.

Stop, look and listen.

When in doubt, don’t UTI.

When in doubt, stop, look and listen.

The patient will almost always have the answer; the befuddlement of dementia or delirium or, aphasia is why we have doctors and nurses – to disentangle the narrative.

That is the challenge. That is the effort.

david prowse

 

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