Urinary Tract Infections in Older Patients

Abstract

Urinary tract infections (UTIs) are the most common infection in older patients, above all when living in a long-term care facility. UTIs are caused by the presence and multiplication of microorganisms in the urinary tract. A UTI can result in several clinical syndromes, including acute and chronic pyelonephritis (infection of the kidney and renal pelvis), cystitis (infection of the bladder), urethritis (infection of the urethra), epididymitis (infection of the epididymis), and prostatitis (infection of the prostate gland). A urinary tract infection is defined by a combination of clinical features and the presence of bacteria in the urine. The diagnosis of UTI is particularly difficult in older patients, who may present with atypical symptoms such as delirium and without a fever.

Older institutionalised patients frequently receive unnecessary antibiotic treatment for asymptomatic bacteriuria (ASB), despite compelling evidence of no clinical benefit. The high prevalence of bacteriuria in long-term care facility patients makes it difficult for providers to distinguish a clinically relevant UTI from ASB, with a consequent overtreatment of ASB, which leads to the development of multidrug-resistant organisms (MDROs). In older patients who have nonspecific symptoms, a holistic assessment should be performed, specifically looking for alternative explanations for the presentation before assuming UTI is the issue. Urine dipstick testing is not useful other than to exclude UTI (high negative predictive value) as it has poor positive predictive value. It is important to know the epidemiology and local resistance patterns, to ensure the correct use of antibiotics.