Age Concern Pty Ltd

Urinary dipsticks—helpful or harmful?

Before we dive into urinary dipsticks, a key point about asymptomatic bacteriuria (ASB): There is no gold standard to distinguish ASB from a true UTI (van Buul et al., 2018). They add that in older adults, treatment decisions should not be based solely on urinalysis or culture results.

About the nitrites and the leukocytes:
🔹 Only gram-negative bacteria convert nitrates to nitrites, but not all UTIs are caused by gram-negative bacteria!
🔹 Leukocyte esterase is an enzyme found in white blood cells, high levels could mean an inflammatory process or contamination.

Many studies challenge the reliability of urinary dipsticks in older adults, including:
📌 Edward et al., 2018 – Standard dipstick tests and urine cultures have moderate accuracy and aren’t reliable for diagnosing UTIs in aged care.
📌 Juthani-Metha et al., 2014 – Even when both nitrite and leukocyte esterase are positive, the predictive value is low.
📌 Public Health England, 2018 – Urinary dipsticks should not be used in primary care for patients over 65.
📌 Ontario Agency for Health Protection and Promotion, 2019 – Evidence supports discontinuing dipstick use in long-term care residents.
📌 Al-Makdase et al., 2020 – “Urine dipsticks and urine cultures are no longer diagnostic tools” due to ASB prevalence.
📌 Eriksen & Bing-Johnsson, 2017 – A systematic review found dipsticks inappropriate for diagnosing UTIs in older patients.

Despite this, it’s common for staff or family members to assume a UTI when an older person becomes more confused—often leading to an immediate dipstick test. But consider this:
🔸 If an in-out catheter isn’t used, is the urine sample truly a clean catch?
🔸 Are potentially contaminated samples being tested with dipsticks or sent to pathology to guide treatment?

Feeling uneasy about moving away from dipsticks? You’re not alone! But interestingly, they are useful for ruling out a UTI, just not ruling a UTI in. 😊

For references and further readings, click the email address in the following comment.

This content is for informational purposes only and should not replace professional clinical judgement. For the full disclaimer, visit our website https://ageconcern.com.au/disclaimer/

I'm diving into all things related to urinary tract infections (UTIs) in older adults living in residential aged care—starting with asymptomatic bacteriuria (ASB).
ASB is when a urine sample shows high levels of bacteria (≥100,000 CFU/mL of a single uropathogen) without any UTI symptoms. Research suggests that 50–90% of female residents in aged care have ASB, yet it's often misinterpreted.
One key issue? Collecting a clean catch urine sample. In theory, that's essential. In practice, it's a challenge. Many aged care residents simply can’t provide one, which makes this a nursing issue. And if we’re serious about antimicrobial stewardship, we need to rethink how we approach testing and treatment in this setting.
Next up in my UTI deep dive: urinary dipsticks. Stay tuned!

The 21-day masterclass has yielded remarkable results for all residents. We have witnessed a decrease in falls (48%); decrease in responsive behaviours (37%), weight gain/stable (68%) as well as a complete elimination of p.r.n. antipsychotic use. These changes were achieved, although 6 new residents were admitted in the last week! ~ Chelsea, Facility Manager