Suspected urinary tract infection

A. No indwelling foley catheter Acute dysuria alone OR temperature >37.9C AND 1 of following*: 1. New or worse frequency 2. Urgency 3. Costovertebral tenderness 4. Gross hematuria 5. Suprapubic pain 6. Mental status change 7. Rigors

Suspected lower respiratory tract infection

A. Temperature >38.9C 1 of following:

Suspected skin infection

New or increased purulent drainage OR 1 of the following*:

Febrile episode
Temperature >37.9C AND 1 of the following: 1. Change in mental status 2. Rigors 3. Unstable vital signs

1. Respiratory rate >25 breaths/minute 2. New productive cough

1. Temperature >37.9C 2. Redness 3. New or increased swelling

B. Temperature <38.9C New productive cough AND 1 of the following: 1. Pulse >100 beats/minute 2. Respiratory rate >25 breaths/minute 3. Rigors 4. Change in mental status

4. Warmth 5. Tenderness

B. Indwelling foley catheter 1 of following: 1. Temperature >37.9C 2. Rigors 3. Change in mental status

C. Afebrile with COPD New/increased cough with purulent sputum

Minimal criteria for initiation of antimicrobial use for suspected infections in nursing home residents with advanced dementia
* Urgency, frequency, skin tenderness, costovertebral tenderness and suprapubic pain may be difficult to evaluate in advanced dementia but accepted criteria if present. Diagnostic criteria for delirium can be diffiicult to evaluate in advanced dementia, therefore any change from baseline men tal status considered. Unstable vital signs = sysolic blood pressure <90 mmHg or heart rate >100 beats/min or respiratory rate >25 breaths/minute.