Catheter‐related Urosepsis in the Elderly: A Prospective Study of Community‐derived Infections

Abstract

For the period 1979-1980, a prospective study was made of 13 elderly patients with catheter-related urosepsis, who required hospitalization. Several features appeared to distinguish these patients: (1) a traumatic catheter-related event invariably preceded the acute symptomatic process, (2) polymicrobic bacteriuria predominated, and (3) the urinary pathogens were often resistant to the antimicrobial agents commonly prescribed for communityassociated symptomatic urinary-tract infections. A diagnostic and therapeutic approach for these patients is outlined.The infected urinary tract has been identified as the most common source for bacteremia in elderly patients admitted to a community hospital.' For the elderly patient, acute symptomatic urosepsis often necessitates hospitalization and occasionally results in death. In the present prospective study we assessed the clinical, bacteriologic, immunologic, and the rape u t i c feature s of s y m p t o m at i c , catheterassociated urosepsis as experienced by 13 consecutive elderly patients who required hospital admission. Our intent was to focus on the features of the disease that appear to be unique to the elderly catheterized patient, and to outline a diagnostic and therapeutic approach for these patients. MATERIALS AND METHODSThis prospective study commenced in December 1979 and was concluded in November 1980. During this period, 4955 patients aged 65 or older were discharged from the medical and surgical services of the hospital.The study group consisted of 13 symptomatic, elderly white febrile patients with indwelling bladder-catheters who were admitted to the hospital because of community-acquired urosepsis. Fever, constitutional symptoms, and "significant" bacteriuria (more than 105 colony-forming units per ml of a recognized urinary pathogen) were required criteria for participation in the study. Patients were excluded if another infection, a neoplasm, or an inflammatory disorder existed that could provide an alternative explanation for the admission fever and symptoms.Vincent Hospital, a 650-bed community hospital and major teaching affiliate of the University of Massachusetts Medical School. The patients' private physicians arid the members of the medical house staff made all the diagnostic and therapeutic decisions.The patients were classified according to the severity of their associated medical illnesses? Identification of septic shock required the presence of fever, altered mental status, and a systolic blood pressure less than 90 mm Hg.3 Patients known to be hypertensive before hospitalization were considered to have sustained shock if their admission systolic blood pressures fell by more than 50 mm Hg.The study received the approval of the institutional review committee for human research of Saint Vincent Hospital. Statistical differences between groups were analyzed with Student's twotailed t-test.Quantitative analysis for bacteriuria was carried out by the calibrated loop technique. Biotyping of Escherichia coli was performed to differentiate bacteria...

A causal probabilistic network for optimal treatment of bacterial infections

“…The percentage of leukocyturia (Leukocyturi) and hematuria (Hematuria) in patients with UTI (the presence of white and red blood cells in the urine) was similar in our databases and in the literature [48], [59], [60]. To complete the tables, the percentage of each urinary symptom, leukocyturia, and hematuria in the general population (without urinary infections) was abstracted from the literature [56], [59], [61], [62], [63], [64], [65], [66], [67], [68].…”

Response to the Article by Holroyd‐leduc Et Al.: The Relationship of Indwelling Urinary Catheters to Death, Length of Hospital Stay, Functional Decline, and Nursing Home Admission in Hospitalized Older Medical Patients

“…3 In one case series, 13 consecutive admissions with urosepsis had catheter obstruction, traumatic manipulation, or removal with an inflated balloon within the previous 72 hours. 4 There is also some evidence that men have more problems with urethral catheters, because the catheter may interfere with drainage of seminal secretions. Urethral catheterization in men is associated with epididymitis, orchitis, scrotal abscess, prostatitis, and prostatic abscess, conditions not present in women.…”

“…All multifocals blur the image of ground-level obstacles when viewed through the lower reading portion. 2,4 Bifocals are also subject to a prismatic jump when fixation moves across the divide between the distance and reading segment, causing an apparent vertical displacement of objects, and the peripheries of progressive addition lenses (PALs or ''varifocals'') distort vision. Optometrists typically advise multifocal wearers to tuck their chin in when stepping to facilitate looking through the upper distance portion of the lenses, which brings ground obstacles into focus.…”

“…Optometrists typically advise multifocal wearers to tuck their chin in when stepping to facilitate looking through the upper distance portion of the lenses, which brings ground obstacles into focus. The greater risk of tripping in multifocals [2][3][4] suggests that this advice is ignored or is inappropriate. It might be more advantageous to encourage elderly individuals, particularly those at high risk of falling, to switch to using single-distance eyeglasses during locomotion.…”

Kinetics and dynamics of tobramycin action in patients with bacteriuria given single doses

“…A variety of approaches have been advocated for the management of such patients, including changing of the catheter and the administration of systemic antimicrobial agents for various lengths of time (3,4,7,14,17). Tobramycin is bactericidal against the majority of gram-negative bacilli, which are the pathogens most frequently encountered in urinary tract infections (9, 14).…”