Urinary tract infection in elderly: clinical profile and outcome study done at Kempegowda Institute of Medical Science and Hospital, Bengaluru, India
Keywords:Antibiotic use, Diabetes mellitus, Elderly, Urinary tract infection
Background: Urinary tract infection (UTI) being the most common bacterial infection with considerable morbidity and mortality. In hospitalized geriatric patients, the risk is more attributable to differing characteristics such as anatomical and hormonal changes, presence of comorbidities such as neurological and urological abnormalities, diabetes mellitus and prolonged indwelling catheter use in hospitals and long-term care facilities.
Methods: A retrospective study of patients admitted to medicine wards of age above 60 years with symptoms of urinary tract infection and positive urine culture spanning over a year were included. Demographic profile, clinical features, predisposing factors, laboratory features, urine culture reports, antimicrobial susceptibility patterns and outcome were noted and analysed.
Results: Of the 120 patients included in our study, 58.2% were males and 41.8% were females. Dysuria was the most common major symptom (77.5%). Diabetes mellitus was the most common Predisposing factor observed in (63.3%) of the patients. Gram negative organism were responsible for (68.27%) of the uropathogen profile; Escherichia coli was the commonest isolate (31.66%) seen. Mortality rate was 29.16%. Significantly higher mortality was seen in patients with diabetes mellitus (p<0.001), complicated UTI (p<0.001), serum creatinine >1.4mg/dl (p<0.001) and increasing number of predisposing factors. Mortality was also associated with higher leucocyte count in the study population.
Conclusions: Urinary tract infection in elderly increases the population mortality and morbidity; and the co morbid factors associated play a key role in the severity of the infection. Early management and appropriate antibiotic therapy will help in preventing antibiotic resistance and also in decreasing the overall geriatric population fatality.
Robichaud S, Blondeau JM. Urinary tract infections in older adults: current issues and new therapeutic options. Geriatrics and Aging. 2008;11:582-8.
Matthews SJ, Lancaster JW. Urinary tract infections in the elderly population. Am J Geriatr Pharmacother. 2011;9:286-309.
Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49:53-70.
Nicolle LE. Urinary tract infection in geriatric and institutionalized patients. Current opinion in urology. Curr Opin Urol. 2002;12:51-5.
Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med. 2012;113(1):14-9.
Yoshikawa TT, Nicolle LE, Norman DC. Management of complicated urinary infection in older patients. J Am Geriatr Soc. 1996;44:1235-41.
Mahesh E, Medha Y, Indumathi VA, Kumar PS, Khan MW, Punith K. Community-acquired urinary tract infection in the elderly. BJMP. 2011;4:a406.
Norman DC, Grahn D, Yoshikawa TT. Fever and aging. J Am Geriatr Soc. 1985;33:859.
Geerlings SE, Stolk RP, Camps MJ, Netten PM, Hoekstra JB, Bouter KP, et al. Asymptomatic bacteriuria may be considered a complication in women with diabetes. diabetes mellitus women asymptomatic bacteriuria Utrecht study group. Diabetes Care. 2000 Jun 1;23(6):744-9.
Chen SL, Jackson SL, Boyko EJ. Diabetes mellitus and urinary tract infection: epidemiology, pathogenesis and proposed studies in animal models. J Urol. 2009; 182(6 Suppl):S51-6.
Gilbert DN. Urinary tract infections in patients with chronic renal insufficiency. Clin J Am Soci Nephrol. 2006 Mar 1;1(2):327-31.
Tal S, Guller V, Levi S, Bardenstein R, Berger D, Gurevich I et al. Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection. J Infect. 2005;50:296-305.
Bagshaw SM, Laupland KB. Epidemiology of intensive care unit-acquired urinary tract infections. Curr Opin Infect Dis. 2006;19:67-71.
Moellering RC Jr. Principle of anti-infective therapy: Enterococcus species, Streptococcus bovis, and Leuconostoc species. In: Mandell G, Bennett JE, Dolin R, eds. Principles and practice of infectious disease. 6th ed. Philadelphia: Churchill Livingstone; 2005:1826-35.
Patterson JE, Sweeney AH, Simms M, Carley N, Mangi R, Sabetta J, Lyons RW. An analysis of 110 serious enterococcal infections. Epidemiology, antibiotic susceptibility, and outcome. Medicine. 1995 Jul;74(4):191-200.
Ramaprasad AV, Jayaram N, Nageshappa G. Urine Culture Sensitivity Pattern in a Private Laboratory Setup. Indian J Pathol Microbiol. 1993;36:119-23.
Bukhary ZA. Candiduria: A review of clinical significance and management. Saudi J Kidney Dis Transpl. 2008;19:350-60.
Lundstorm T, Sobel JD. Nosocomial candiduria: A review. Clin Infect Dis. 2001;32(11):1602-7.
Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341 (25):1906-12.
Mnif MF, Kamoun M, Kacem HF, Bouaziz Z, Charfi N, Mnif F, et al. Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management. Indian J Endocrinol Metab. 2013;17:442-5.