Varenicline-mediated cholinergic activation through α4β2 nAChR inhibits microglial neuroinflammation and alleviates neuropathic pain and depression following spinal cord injury.

Urinary tract infection (UTI) is a major cause of antibiotic prescriptions in the older population [, ]. Antibiotic treatment for UTI reduces symptoms and helps prevent serious complications. However, frequent antibiotic treatment leads to the selection of resistant strains, increases healthcare costs, and exposes people to potential adverse effects. These risks are particularly relevant in older adults, who are more vulnerable to adverse drug reactions, drug–drug interactions, and complications such as infections []. Therefore, it is crucial to accurately diagnose UTI in older adults and to avoid unnecessary antibiotic treatment. This is particularly challenging in older adults, in whom a higher prevalence of cognitive disorders may limit the reliability of the medical history. In addition, other age-associated urological conditions, such as genitourinary syndrome of menopause, cystocele, or prostate hypertrophy, can mimic the symptoms of UTI []. In clinical practice, the presence of pyuria or bacteriuria is often used as an indicator of UTI. However, asymptomatic bacteriuria (ASB) and leukocyturia are extremely common in older adults, particularly women, with reported ASB in up to 59% of women. Among those with ASB, 90% have leukocyturia as well [–]. As a result, urine tests that solely rely on these markers, such as the urine dipstick, may perform poorly in distinguishing true infection from colonization, further raising questions about the dipstick’s clinical value in routine care for older adults. The urine dipstick is a rapid and inexpensive screening tool that detects nitrite, produced by most Enterobacterales, and leukocyte esterase (LE), an enzyme released by neutrophils []. Although appealing for its speed and simplicity, its diagnostic accuracy in older adults is uncertain. Most previous studies have compared dipstick results with urine cultures as the reference standard; however, culture alone cannot reliably distinguish ASB from a true infection, leading to potential misclassification [, ]. Moreover, studies that have applied more comprehensive diagnostic criteria rarely included older populations specifically [–].