{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T06:17:47Z","timestamp":1793427467759,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T00:00:00Z","timestamp":1495152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2017,8]]},"abstract":"\n \u201cUrinary tract infection\u201d (\u201c\n UTI<\/jats:styled-content>\n \u201d) is an ambiguous, expansive, overused diagnosis that can lead to marked, harmful antibiotic overtreatment. \u201cSignificant bacteriuria,\u201d central to most definitions of \u201c\n UTI<\/jats:styled-content>\n ,\u201d has little significance in identifying individuals who will benefit from treatment. \u201cUrinary symptoms\u201d are similarly uninformative. Neither criterion is well defined. Bacteriuria and symptoms remit and recur spontaneously. Treatment is standard for acute uncomplicated cystitis and common for asymptomatic bacteriuria, but definite benefits are few. Treatment for \u201c\n UTI<\/jats:styled-content>\n \u201d in older adults with delirium and bacteriuria is widespread but no evidence supports the practice, and expert opinion opposes it.\n <\/jats:p>\n \n Sensitive diagnostic tests now demonstrate that healthy urinary tracts host a ubiquitous, complex microbial community. Recognition of this microbiome, largely undetectable using standard agar\u2010based cultures, offers a new perspective on \u201c\n UTI<\/jats:styled-content>\n .\u201d Everyone is bacteriuric. From this perspective, most people who are treated for a \u201c\n UTI<\/jats:styled-content>\n \u201d would probably be better off without treatment. Elderly adults, little studied in this regard, face particular risk. Invasive bacterial diseases such as pyelonephritis and bacteremic bacteriuria are also \u201c\n UTI<\/jats:styled-content>\n s.\u201d\n <\/jats:p>\n \n Mindful decisions about antibiotic use will require a far better understanding of how pathogenicity arises within microbial communities. It is likely that public education and meaningful informed\u2010consent discussions about antibiotic treatment of bacteriuria, emphasizing potential harms and uncertain benefits, would reduce overtreatment. Emphasizing the microbiome's significance and using the term \u201curinary tract dysbiosis\u201d instead of \u201c\n UTI<\/jats:styled-content>\n \u201d might also help and might encourage mindful study of the relationships among host, aging, microbiome, disease, and antibiotic treatment.\n <\/jats:p>","DOI":"10.1111\/jgs.14907","type":"journal-article","created":{"date-parts":[[2017,5,23]],"date-time":"2017-05-23T11:39:45Z","timestamp":1495539585000},"page":"1650-1655","source":"Crossref","is-referenced-by-count":71,"title":["\u201cUrinary Tract Infection\u201d\u2014Requiem for a Heavyweight"],"prefix":"10.1111","volume":"65","author":[{"given":"Thomas E.","family":"Finucane","sequence":"first","affiliation":[{"name":"Johns Hopkins Bayview Medical Center Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/650482"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02876-13"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/427507"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2015.00014"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(02)80328-7"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(56)90175-9"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.20.2701"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(86)90391-8"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2010.03284.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2008.12.009"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2010.190"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h6544"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1104429"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540410019642"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.08.018"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2012.01452.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.10.016"},{"key":"e_1_2_7_19_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5770\/cgj.17.90","article-title":"Delirium, a symptom of UTI in the elderly: Fact or fable? A systematic review","volume":"17","author":"Balogun SA","year":"2013","journal-title":"Can Geriatr J"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2005.00470.x"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu235"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.05852-11"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis534"},{"key":"e_1_2_7_25_1","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1093\/cid\/civ696","article-title":"Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infections","volume":"61","author":"Cai T","year":"2015","journal-title":"Clin Infect Dis"},{"key":"e_1_2_7_26_1","volume-title":"Thinking Fast and Slow","author":"Kahneman D","year":"2011"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu010"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1086\/667743"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1086\/595683"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1086\/501875"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12226"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.14907","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.14907","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T12:52:40Z","timestamp":1762174360000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.14907"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,19]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1111\/jgs.14907"],"URL":"https:\/\/doi.org\/10.1111\/jgs.14907","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,19]]}}}