Re: The Scientific Evidence for a Potential Link between Confusion and Urinary Tract Infection in the Elderly is Still Confusing-A Systematic Literature Review.

available at http://www.ncbi.nlm.nih.gov/pubmed/30717706 Editorial Comment: Differentiation between asymptomatic bacteriuria and actual urinary tract infection (UTI) is one of the more challenging tasks in geriatric urology. Confusion is often cited as a symptom that may be caused by UTI. The problem is that confusion can be a relatively common and somewhat generic symptom, and may be caused by a multitude of factors in addition to UTI. This systematic literature review was designed to examine the published scientific evidence linking these conditions. A total of 1,702 original research studies were identified, of which 22 met inclusion criteria for analysis. Interestingly while 8 studies identified confusion using validated criteria, none of the studies used validated criteria to define UTIs. This finding emphasizes the widespread differences of opinion that are rife in this clinical arena. In fact, only 1 study had established definitions of confusion and bacteriuria that met scientific thresholds. Because of these methodological problems, rates of reported associations between confusion and UTI were widely disparate between studies, and the research was considered of generally poor quality. This article stresses the importance of high quality research using established, objective measures for confusion, bacteriuria and UTI to actually assess these clinical relationships in older adults. Based on their observations, the authors specifically call for randomized controlled clinical trials examining these issues. Tomas L. Griebling, MD, MPH 1042 GERIATRICS Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.