Harnwegsinfekte im Alter

Abstract

Acute infection of the urinary tract is one of the most commonly encountered bacterial infections in the frail elderly population and is responsible for substantial morbidity and recurrent infections with antibiotic resistance. Although generally considered to be self-limiting without treatment or easily treated with a short antibiotic regime, urinary tract infections (UTIs) often have a dramatic history, associated with incomplete resolution and frequent recurrence. The biological complexity of the infections combined with a dramatic rise in antibiotic-resistant pathogens highlight the need for an anticipating strategy for therapy necessary for a rapid recovery. The first crucial step is the classification in asymptomatic bacteriuria or complicated pyelonephritis, on which the decision for the intensity of treatment and diagnostic effort is based. For the selection of empiric antibiotic therapy, knowledge about the predominant uropathogens as well as local resistance patterns is important. In this manner, most urinary tract infections in the elderly can be treated without greater expense.

Qualitätsmessung mit Routinedaten in deutschen Pflegeheimen: Eine erste Standortbestimmung

“…Erhebung) des European Centre for Disease Prevention and Control (ECDC 2013) ergaben Punktprävalenzmessungen von Infektionen in deutschen Pflegeheimen, dass es sich bei knapp einem Drittel (28,4 %) aller aufgetretenen Infektionen um HWI handelte (0,8 % der 17.208 Pflegeheimbewohner der Studie), in 90,1 % lagen jedoch keine mikrobiologischen Befunde vor (Ruscher et al 2015). Einigkeit besteht darin, dass betagte Pflegeheimbewohner, insbesondere Frauen, sowohl ein hohes Risiko für HWI aufweisen als auch ein hohes Risiko für Komplikationen, Folgeerkrankungen, rezidivierende Infektionen sowie die Ausbildung von Antibiotikaresistenzen (Becher et al 2015;DGU 2017;KRINKO 2015;Wischnewski et al 2011). Neben diesen intrapersonellen Risikofaktoren begünstigen unzureichende Präventivmaßnahmen, insbesondere zur Händehygiene und zum Umgang mit Blasenkathetern, das Entstehen von HWI.…”

Occurrence and Antibiotic Susceptibility Profiles of Biofilm-forming Bacteria Associated with Asymptomatic Bacteriuria Among Students

“…While E. coli may be associated with urine samples of healthy persons P. aeruginosa and other multidrug-resistant polymicrobial flora may be associated with a catheterized patient. However, Enterococcus species and Gram-negative bacilli may prevail in the urine samples of men 10,11 . It has been recommended that patients with ABU should not be treated except if there is an associated potential benefit.…”

Geriatric Patients and Symptomatic Urinary Tract Infections: Analysis of Bacterial Range and Resistance Rates at a 3rd Level of Care Hospital in Germany

“…Additionally, incidence of UTIs in the elderly varies according to their living situation: in patients living selfsufficiently at home, only half as many UTI cases occur as compared to nursing home patients [9,10]. Diagnosing UTI in geriatric patients is sometimes difficult.…”

“…These difficulties in diagnosing UTI in the elderly explain frequent hospital admissions due to UTI exacerbation, as UTIs are easily overlooked and therefore allowed to progress untreated – with sometimes grave consequences in frail patients [9]. On the other hand, due to unspecific symptoms, overdiagnosis and overtreatment of UTI in geriatric patients is common as well [12].…”