The factors affecting inadequate empirical antimicrobial therapy and clinical course in upper urinary tract infections of the elderly patients (original) (raw)
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European Journal of Internal Medicine
Background Inadequate empirical antimicrobial therapy (IEAT) in intensive care unit (ICU) is associated with adverse outcomes. However, the influence of IEAT on prognosis for elderly patients with urinary tract infection (UTI) in non-ICU settings is unknown. Methods A retrospective cross-sectional study of elderly patients admitted to a non-ICU ward in a university hospital with a primary diagnosis of UTI over a 3-year period was done. Data relating to age, sex, background comorbidities, severity of infection, bacteremia, microorganisms isolated in urine, treatment given, length of stay and prognosis were obtained using chart review. Cases were segregated according to the adequacy of empirical antimicrobial therapy. In-hospital mortality rate was the main outcome variable evaluated. Results A total of 270 patients with a mean age of 83.7 years were studied. Sixty-eight percent were health-care associated infections. Seventy-nine (29.3%) cases received IEAT. IEAT was associated with ...
Optimal management of urinary tract infections in older people
Clinical Interventions in Aging, 2011
Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials.
Age and ageing, 2018
clinical guidelines recommend antibiotic prophylaxis for preventing recurrent urinary tract infections (UTIs), but there is little evidence for their effectiveness in older adults. this was a retrospective cohort study of health records from 19,696 adults aged ≥65 with recurrent UTIs. We used prescription records to ascertain ≥3 months' prophylaxis with trimethoprim, cefalexin or nitrofurantoin. We used random effects Cox recurrent event models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of clinical recurrence (primary outcome), acute antibiotic prescribing and hospitalisation. of 4,043 men and 15,653 women aged ≥65 with recurrent UTIs, 508 men (12.6%) and 2,229 women (14.2%) were prescribed antibiotic prophylaxis. In men, prophylaxis was associated with a reduced risk of clinical recurrence (HR, 0.49; 95% CI, 0.45-0.54), acute antibiotic prescribing (HR, 0.54; 95% CI, 0.51-0.57) and UTI-related hospitalisation (HR, 0.78; 95% CI, 0.64-0.94). In wom...
Evaluation of urinary tract infections in geriatric patients attending a tertiary care hospital
Panacea Journal of Medical Sciences, 2020
In geriatric patients, urinary tract infections (UTIs) can pose quite a challenge to the treating clinicians regarding the approach for diagnosis, treatment, and prevention as the patients frequently present with symptoms which may be nonspecific and are associated with comorbid conditions. Aims and Objectives: The study aimed to determine the frequency and specificity of the clinical features of UTI in the geriatric group and their relationship with characteristics that define functional ability in them. Materials and Methods: A total of 380 geriatric patients were recruited for the study. Associated symptoms, isolation of recognized pathogen on culture and evidence of white blood cells in the urine were taken as criteria for diagnosing UTI in these patients. Results: Out of 380 patients recruited in our study 56.31% were males and 43.68% comprised of females. Burning micturition was a predominant symptom in both males (66.8%) and females (72.2%). Most common predisposing factor was diabetes mellitus in 61% of the geriatric population in our study. Escherichia coli was the predominant organism isolated from specimens of 59.73% patients. Mortality rate in our study was 10.26%. There was a significant association (P value <0.001) between diabetes mellitus and the mortality rate. Statistically significant high mortality rate was also seen in patients with chronic kidney disease (P value <0.00001) and with increasing number of predisposing factors (P value <0.00725). Conclusion: Considering the potential for serious complications and mortality in the elderly patients with UTI they should be clinically evaluated systematically specifying a necessity for prompt diagnostic vigilance.
Aging Clinical and Experimental Research, 2015
Background Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host. Aims The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs. Methods We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the ''Fondazione San Raffaele Cittadella della Carità'', Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI. Results P-UTIs were detected in 118/299 (39 %) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95 % CI 1.06-2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95 % CI 1.13-3.11; P = .015). Discussion The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases. Conclusions Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity.
The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie médicale / AMMI Canada
The prevalence of asymptomatic bacteriuria among residents of long-term care (LTC) facilities is high, and is a source of inappropriate antibiotic prescription. To establish symptoms and signs associated with a positive urine culture, and to determine whether antibiotic therapy is associated with functional improvement. A total of 101 LTC patients were prospectively observed after submission of urine for culture. The culture positivity rate was consistent with the expected asymptomatic bacteriuria rate. Change in mental status and male sex were associated with culture positivity. Treatment decisions were not consistent with culture results. Treatment did not lead to improvement in activities of daily living scores at two days or seven days. Significant growth cannot be well predicted based on clinical variables; thus, the decision to submit urine is somewhat arbitrary. Because urine culture testing and treatment does not lead to functional improvement, restricting access to the test...
Antibiotics, 2021
The ageing of the population—especially in developed countries—has brought on many societal challenges and has significantly contributed to the burden on healthcare infrastructures worldwide. Elderly persons (aged ≥ 65 years) are at higher risk for developing UTIs, due to a range of intrinsic and extrinsic risk factors, and they often delay seeking treatment. A retrospective observational study was performed regarding the epidemiology and resistance of UTIs in elderly patients. Identification of the isolates was carried out using VITEK 2 ID/AST and MALDI-TOF mass spectrometry. Antibiotic resistance in these isolates was assessed based on EUCAST guidelines, and were grouped into the WHO AWaRe (Access, Watch, Reserve) classification of antimicrobials. During the 10-year study period, n = 4214 (421.4 ± 118.7/year) and n = 4952 (495.2 ± 274.6) laboratory-confirmed UTIs were recorded in inpatients and outpatients, respectively. The causative agents showed differentiation among outpatient...