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Nephro Uro andrology
Mental Retardation

Urinary Tract Infection

Urinary Tract Infection

Factors that predispose the elderly to bacteriuria are :
  • Anatomic (e.g. prostate enlargement, pelvic prolapse with cystocoele) and
  • Urodynamic (e.g. increased residual urine, less efficient emptying of bladder)
  • Functional disability
  • Incontinence
  • Use of indwelling catheters
  • Age-associated changes in urothelial defense mechanisms.

Asymptomatic bacteriuria

Asymptomatic bacteriuria is common in geriatric populations. Most geriatricians recommend against antibiotic treatment of asymptomatic bacteriuria. Treatment exposes patients to the risk of drug side effects and selection of resistant organisms, without appreciable reduction in morbidity or mortality.

Pyelonephritis

Older patients are frequently infected with drug-resistant organisms. Healthy, ambulatory, non-catheterised elderly persons generally have Escherichia coli as a predominant urinary tract organism (as do younger persons). The risk of polymicrobial and drug-resistant infection increases with
  • Previous antibiotic use
  • Frequency of hospitalisation
  • Nursing home admission
  • Presence of a chronic indwelling catheter
  • Underlying medical conditions that impair their immune status or complicate treatment.
Age-associated decline in renal function makes treatment with nephrotoxic antibiotics (e.g. aminoglycosides) potentially dangerous. Treatment of pyelonephritis in the elderly almost always requires hospitalisation and treatment with broad-spectrum parenteral antibiotics. Since urine and/or blood culture results are generally not available until 24 to 48 hours after treatment is started, initial therapy is empirical. Although many antibiotic agents have been suggested, third-generation cephalosporins are generally the preferred agents for treatment of uncomplicated pyelonephritis. This group of antibiotics provides activity against nearly all common geriatric urinary pathogens (except enterococcus) and has negligible nephrotoxicity. In patients with serious complications of pyelonephritis, such as septic shock, most experts recommend administration of an aminoglycoside in addition to a third-generation cephalosporin. Dosage adjustment based on renal function and careful monitoring of aminoglycoside blood levels is essential. After clinical improvement has occurred and reports of antimicrobial sensitivity patterns are available, antibiotic treatment can be modified as appropriate. Catheter-associated infection:
  • Since bacteriuria is so common among chronically catheterised patients, colonisation should be expected. With the exception of symptomatic patients (e.g. those with fever, flank pain, sepsis), no evidence shows that treatment decreases morbidity or mortality.
  • If the patient becomes symptomatic, the initial choice of antibiotic is based on the same considerations described for the treatment of pyelonephritis. Subsequent modification of the antibiotic regimen can be based on culture results when they become available.
Clinical-Features Pathophysiology Approach To The Patient Complications Investigations Prognosis Management Take Home Message

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