“Urinary tract infections” (UTIs) are overdiagnosed. Antibiotics are overprescribed. UTIs are inappropriately blamed for geriatric syndromes (eg delirium) despite little supporting evidence. Our guest, Tom Finucane MD, Emeritus Professor of Medicine at Johns Hopkins makes us question everything. Topics: How can we diagnose “UTI”? Who needs treatment? Do urinary tract symptoms matter? Does malodorous urine correlate with infection? Who’s at risk for pyelonephritis and sepsis? Don’t miss this paradigm changing episode. And stop using the term “urinary tract infection” unless it’s prefaced by air quotes!

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Credits

Written and produced by: Matthew Watto MD

Hosts: Matthew Watto MD, Paul Williams MD

Edited by: Matthew Watto MD

Guest: Tom Finucane MD, MACP

Time Stamps

00:00 Disclaimer, intro and guest bio
04:00 Guest one liner, book recommendation, career advice
08:22 The “medical ignorome”
13:40 ACP Internal Medicine Meeting 2019 details
16:20 Case of malodorous urine; Urine is NOT sterile; Defining terms
25:14 Stop saying UTI unless using air quotes
28:34 What symptoms or history matters in evaluation for “UTI”? And can we predict who will become systemically ill?
34:47 Voltaire and when treatment is warranted for “urinary tract infections”
37:15 Delirium in an older adult with possible UTI, how to work it up, and who warrants antibiotics
51:55 Take home points
53:38 Outro

#134 Urinary Tract Infections Delirium and Voltaire

The Curbsiders Internal Medicine Podcast