Predictive factors of urinary tract infections among the oldest old in the general population. a population-based prospective follow-up study

Abstract

BackgroundUrinary tract infections (UTI) are common among the oldest old and may lead to a few days of illness, delirium or even to death. We studied the incidence and predictive factors of UTI among the oldest old in the general population.MethodsThe Leiden 85-plus Study is a population-based prospective follow-up study of 86-year-old subjects in Leiden, The Netherlands. Information on the diagnosis of UTI was obtained annually during four years of follow-up from the medical records and interviews of treating physicians. A total of 157 men and 322 women aged 86 years participated in the study. Possible predictive factors were collected at baseline, including history of UTI between the age of 85 and 86 years, aspects of functioning (cognitive impairment (Mini-Mental State Examination (MMSE) < 19), presence of depressive symptoms (Geriatric Depression Scale (GDS) > 4), disability in activities of daily living (ADL)), and co-morbidities.ResultsThe incidence of UTI from age 86 through 90 years was 11.2 (95% confidence interval (CI) 9.4, 13.1) per 100 person-years at risk. Multivariate analysis showed that history of UTI between the age of 85 and 86 years (hazard ratio (HR) 3.4 (95% CI 2.4, 5.0)), impaired cognitive function (HR 1.9 (95% CI 1.3, 2.9)), disability in daily living (HR 1.7 (95% CI 1.1, 2.5)) and urine incontinence (HR 1.5 (95% CI 1.0, 2.1)) were independent predictors of an increased incidence of UTI from age 86 onwards.ConclusionsWithin the oldest old, a history of UTI between the age of 85 and 86 years, cognitive impairment, ADL disability and urine incontinence are independent predictors of developing UTI. These predictive factors could be used to target preventive measures to the oldest old at high risk of UTI.

Urinary Tract Infection Treatment Pattern of Elderly Patients in a Tertiary Hospital Setup in South India: A Prospective Study

“…1729) &: $ 40.10 (Rs. 2628) ( Table 3, 4,5). Cephalosporin combination with β-lactamase inhibitors was the most prescribed class of antibiotic 38 (36%) followed by penicillin in combination with β-lactamase inhibitors, because of good spectrum of activity and suggestive culture sensitivity.…”

“…2,3 However, between females and males, the ratio varies from geriatrics (50:1) to younger (2:1) population. 4 Diagnosis and treatment of UTI in elderly varies when compare to younger patients and is quiet difficult due to the non-specific/absence of symptoms and lack of clear clinical history. 5 This lead toits under-diagnosisandlack of treatment.…”

“…Even studies reported that the UTI was caused due to urinary incontinence, previous history, urogenital surgery and diabetes mellitus in specific patient populations. 3,4 Bacteria is the most common causative agent in humans. Even though sometimes viruses and fungi can also be observed, hence this should not be ignored.…”

Incidence of Antibiotic-Resistant Escherichia coli Bacteriuria According to Age and Location of Onset: A Population-Based Study From Olmsted County, Minnesota

“…This is consistent with the findings that rates of bacteriuria and UTI increase with age. 26,[28][29][30] Risk factors for UTI in elderly individuals include cognitive impairment, urinary incontinence, and inability to perform activities of daily living. 30 Notably, during the study period, drug-resistant strains replaced drug-susceptible ones among patients older than 65 years because the incidence of overall bacteriuria did not change but the incidence of drug-resistant bacteriuria (with isolates resistant to fluoroquinolones, fluoroquinolone plus trimethoprim-sulfamethoxazole, or Ͼ3 drug classes) nearly doubled.…”

“…26,[28][29][30] Risk factors for UTI in elderly individuals include cognitive impairment, urinary incontinence, and inability to perform activities of daily living. 30 Notably, during the study period, drug-resistant strains replaced drug-susceptible ones among patients older than 65 years because the incidence of overall bacteriuria did not change but the incidence of drug-resistant bacteriuria (with isolates resistant to fluoroquinolones, fluoroquinolone plus trimethoprim-sulfamethoxazole, or Ͼ3 drug classes) nearly doubled. Patients 80 years and older contributed nearly 40% of the nosocomial and HA E coli isolates in our study, suggesting that well-described risk factors, such as residence in long-term care facilities, 31,32 prior antimicrobial exposure, [33][34][35][36] or use of urinary catheters, 27,37,38 are likely contributing to emerging drug resistance in this group of patients.…”