Ugalde GF, Rivera GH, Obando SSN

Language: Spanish
References: 15
Page:
PDF size: 165.37 Kb.

ABSTRACT

Urinary tract infection is the most common location of infectious pathology in the elderly. It can occur as a recurrent infection, which means three or more symptomatic episodes per year, or more than two infections in 6 months. It could appear as an uncomplicated or complicated disease. The last one usually appears in people with functional or structural abnormalities and mainly affects the upper urinary tract. In the elderly there is a high prevalence of urinary symptoms (incontinence, urgency, frequency, nocturia), but those symptoms are not always related to an infection. For this reason, the physiological changes associated with aging must be distinguished from pathological alterations. To achieve an adequate diagnosis, it is mandatory to do a detailed interrogatory, which includes information provided by the patient and the caregiver, a physical examination and laboratory tests as needed, only if clinical symptoms are found, since the tests by themselves are not capable of differentiating asymptomatic bacteriuria from a urinary tract infection. Asymptomatic bacteriuria should not be screened or treated in the elderly. It is important to highlight that if treatment is indicated, it should be prescribed with caution, since providing unnecessary therapies causes microbial resistance, without achieving any survival benefit.

REFERENCES

1. Halter JB, Ouslander JG, Studenski S, Asthana S, Supiano MA, et al. Hazzard’s geriatric medicine and gerontology, 7th ed. New York, NY: McGraw-Hill Professional. 2016.

2. Rojas Oviedo PD. Infecciones del tracto urinario, bacteriuria asintomática en el adulto mayor. Revista Geriatría Clínica. 30 de marzo, 2018;12(1). Recuperado a partir de: http://adm.meducatium.com.ar/contenido/articulos/15300130017_1074/pdf/15300130017.pdf

3. Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary tract infection and asymptomatic bacteriuria in older adults. Infect Dis Clin North Am [Internet]. 2017;31(4):673–88. Doi: http://dx.doi.org/10.1016/j.idc.2017.07.002

4. Mody L. Approach to infection in the older adult. UpToDate [Internet]. [cited Apr 21, 2022]. Available from: https://www.uptodate.com/contents/approach-to-infection-in-the-older-adult

5. Meyrier A. Sampling and evaluation of voided urine in the diagnosis of urinary tract infection in adults. UpToDate [Internet]. [cited Apr 21, 2022]. Available from: https://www.uptodate.com/contents/sampling-and-evaluation-of-voided-urine-in-the-diagnosis-of-urinary-tract-infection-in-adults

6. Álvarez Villarraga J, Parra J, Díaz D, Chavarriaga J, Godoy MP, Cárdenas AM. Guía de práctica clínica de infección de vías urinarias en el adulto. Rev Urol Colomb / Colomb Urol J [Internet]. 2018;27(02):126–31. Doi: http://dx.doi.org/10.1055/s-0038-1660528

7. Leoni AF, Monterisi A, Acuña PG. Community acquired urinary tract infections in older adults. Rev Fac Cien Med Univ Nac Cordoba. 2017;74(1):10–7. Disponible a partir de: https://pubmed.ncbi.nlm.nih.gov/28379126/

8. Zeng G, Zhu W, Lam W, Bayramgil A. Treatment of urinary tract infections in the old and fragile. World J Urol [Internet]. 2020;38(11):2709–20. Doi: http://dx.doi.org/10.1007/s00345-020-03159-2

9. Gajdács M, Ábrók M, Lázár A, Burián K. Urinary tract infections in elderly patients: A 10-year study on their epidemiology and antibiotic resistancebased on the WHO Access, Watch, Reserve (AWaRe) classification. Antibiotics (Basel) [Internet]. 2021;10(9):1098. Doi: http://dx.doi.org/10.3390/antibiotics10091098

10. Imatoh T, Nishi T, Yasui M, Maeda T, Sai K, Saito Y, et al. Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients: A retrospective cohort study. Pharmacoepidemiol Drug Saf [Internet]. 2018;27(8):931–9. Doi: http://dx.doi.org/10.1002/pds.4560

11. Rodríguez-Mañas L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs Context [Internet]. 2020;9:1–8. Doi: http://dx.doi.org/10.7573/dic.2020-4-13

12. Froom P, Shimoni Z. The uncertainties of the diagnosis and treatment of a suspected urinary tract infection in elderly hospitalized patients. Expert Rev Anti Infect Ther [Internet]. 2018;16(10):763–70. Doi: http://dx.doi.org/10.1080/14787210.2018.1523006

13. Gharbi M, Drysdale JH, Lishman H, Goudie R, Molokhia M, Johnson AP, et al. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. BMJ [Internet]. Feb 27, 2019 [cited May 02, 2022];l525. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391656/

14. Leihof RF, Nielsen KL, Frimodt-Møller N. Asymptomatic Bacteriuria (ABU) in Elderly: Prevalence, Virulence, Phylogeny, Antibiotic Resistance and Complement C3 in Urine. Microorganisms [Internet]. 9(2):390. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918685/pdf/microorganisms-09-00390.pdf

15. Shimoni Z, Cohen R, Froom P. Prevalence, impact, and management strategies for asymptomatic bacteriuria in the acute care elderly patient: a review of the current literature. Expert Rev Anti Infect Ther [Internet]. 2020;18(5):453–60. Doi: http://dx.doi.org/10.1080/14787210.2020.1746642.