Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Geriatrics Reports
Published in: Current Geriatrics Reports 3/2013

01-09-2013 | Infectious Diseases in the Elderly (SF Bradley, Section Editor)

Issues in the Diagnosis and Management of Urinary Tract Infections in the Older Adult

Author: Lindsay E. Nicolle

Published in: Current Geriatrics Reports | Issue 3/2013

Login to get access

Abstract

Urinary tract infection is a common problem of elderly populations. Clinical trials addressing urinary infection in the elderly frequently use nonstandardized diagnostic criteria, which compromises the validity of conclusions. Studies of prevention of infection in postmenopausal women in the community consistently report outcomes similar to observations in premenopausal women. Antimicrobial prophylaxis or self-treatment is effective, and cranberry products or probiotics are not beneficial. Critical evaluation of nursing home populations reports no association between nonspecific, nonlocalizing symptoms of any duration and bacteriuria. Optimal antimicrobial use for urinary infection, particularly for residents of long term care facilities, remains challenging. A high proportion of residents in some facilities receive prophylactic therapy to prevent urinary tract infections without evidence to support this practice. Evaluations of multifaceted antimicrobial stewardship programs to improve antimicrobial use in nursing homes report modest benefits.
Literature
1.
Nicolle LE. Urinary tract infections in the elderly. Clin Geriat Med. 2009;25:423–36.CrossRef
2.
Beveridge LA, Davey PG, Phillips G, McMurdo MET. Optimal management of urinary tract infections in older people. Clin Interv Aging. 2011;6:173–80.PubMedCrossRef
3.
Ariathianto Y. Asymptomatic bacteriuria. Prevalence in the elderly population. Aust Fam Physician. 2011;40:805–9.PubMed
4.
Buhr GT, Genao L, White HK. Urinary tract infections in long-term care residents. Clin Geriatr Med. 2011;27:229–39.PubMedCrossRef
5.
Marques LPJ, Flores JT, Barros Jr O, Rodrigues GB, Mourao C, Moreira RMP. Epidemiological and clinical aspects of urinary tract infection in community-dwelling elderly women. Braz J Infect Dis. 2012;16:436–41.PubMedCrossRef
6.
• Caljouw MAA, den Elzen WPJ, Cools HJM, Gussekloo J. Predictive factors of urinary tract infections among the oldest in the general population. A population-based prospective follow-up study. BMC Med. 2011;9:57. This prospective population based study describes the frequency of urinary infection in a cohort of subjects over 85 years of age. Independent predictors of urinary infection in community subjects were functional impairment and prior urinary infection, similar to observations in long term care facility residents.PubMedCrossRef
7.
Arinzon Z, Shabat S, Peisakh A, Berner Y. Clinical presentation of urinary tract infection (UTI) differs with aging in women. Arch Gerontol Geriatr. 2012;55:145–7.PubMedCrossRef
8.
Zhong YH, Fang Y, Zhou JZ, et al. Effectiveness and safety of patient-initiated single-dose versus continuous low-dose antibiotic prophylaxis for recurrent urinary tract infections in postmenopausal women: a randomized controlled study. J Int Med Res. 2011;39:2335–43.PubMedCrossRef
9.
Takahashi S, Hamasuna R, Yasuda M, et al. A randomized clinical trial to evaluate the preventive effect of cranberry juice (UR65) for patients with recurrent urinary tract infection. J Infect Chemother 2012; Sep 8. (Epub ahead of print).
10.
•• Beerepoot MAJ, ter Riet G, Nys S, Stobberingh E, Geerlings SE. Lactobacilli vs antibiotics to prevent urinary tract infections. Arch Intern Med. 2012;172:704–12. For post-menopausal women with frequent recurrent urinary tract infection, trimethoprim/sulfamethoxazole prophylaxis was superior to oral probiotic capsules for prevention. This benefit was restricted to women with uncomplicated urinary tract infection.PubMedCrossRef
11.
Caterino JM, Ting SA, Sisbarro SG, et al. Age, nursing home residence, and presentation of urinary tract infection in U.S. emergency departments, 2001-2008. Acad Emerg Med. 2012;19:1173–80.PubMedCrossRef
12.
•• Sundvall P-D, Ulleryd P, Gunnarsson RK. Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes. BMC Fam Pract. 2011;12:36. This study examined the correlation of bacteriuria with a wide range of nonspecific symptoms of varying duration among nursing home residents. No symptoms had prognostic value for identifying bacteriuria. It was concluded that obtaining urine cultures in these individuals was unhelpful for clinical management.PubMedCrossRef
13.
•• Das R, Towle V, Van Ness PH, Juthani-Mehta M. Adverse outcomes in nursing home residents with increased episodes of observed bacteriuria. Infect Cont Hosp Epidemiol. 2011;32:84–6. An increasing number of episodes of bacteriuria with pyuria identified in female residents was associated with increased antimicrobial use and isolation of multiply drug resistant gram negative rods, but not with changes in mental status or hospitalization for urinary infection. The adverse events were those of inappropriate antimicrobial use rather than attributable to bacteriuria.CrossRef
14.
Lin S-Y. A pilot study – fluid intake and bacteriuria in nursing home residents in southern Taiwan. Nursing Res. 2013;62:66–72.CrossRef
15.
• 15. Bianco L, Perrelli E, Towle V, et al. Pilot randomized controlled dosing study of cranberry capsules for reduction of bacteriuria plus pyuria in female nursing home residents. Jour Amer Ger Soc 60:1180-1181. This pilot study reported no decrease in bacteriuria in residents given any of three doses of cranberry capsules compared with placebo.
16.
Jonsson K, Claesson BEB, Hedelin H. Urine cultures from indwelling bladder catheters in nursing home patients: a point prevalence study in a Swedish county. Scand J Urol Nephrol. 2011;45:265–9.PubMedCrossRef
17.
Chung Y-C, Chen H-H, Yeh M-L. Vinegar for decreasing catheter-associated bacteriuria in long-term catheterized patients: a randomized controlled trial. Biol Res Nurs. 2012;14:294–301.PubMedCrossRef
18.
Haasum Y, Fastbom J, Johnell K. Different patterns in use of antibiotics for lower urinary tract infection in institutionalized and home-dwelling elderly: a register-based study. Eur J Clin Pharmacol. 2013;69:665–71.PubMedCrossRef
19.
Fagan M, Maehlen M, Lindbaek M, Berild D. Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: Compliance with national guidelines. Scand J Prim Health Care. 2012;30:10–5.PubMedCrossRef
20.
• Bergman J, Schjott J, Blix HS. Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription? BMC Geriatr. 2011;11:69. A point prevalence survey in Norwegian nursing homes reported that 18 % of residents were receiving prophylaxis for urinary infection, despite there being no evidence to support prophylactic use in this setting.PubMedCrossRef
21.
Phillips CD, Adepoju O, Stone N, et al. Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes. BMC Geriatr. 2012;12:73.PubMedCrossRef
22.
•• Rummukainen J-L, Jakobsson A, Matsinen M, et al. Reduction in inappropriate prevention of urinary tract infections in long-term care facilities. Am J Infect Control. 2012;40:711–4. The authors developed and tested a multifaceted intervention to decrease the use of prophylactic antimicrobials for urinary infection in Finnish long term care facilities. There was a significant decrease in the proportion of residents receiving antimicrobial prophylaxis for urinary infection, which was attributed to the intervention program.PubMedCrossRef
23.
• Pettersson E, Vernby A, Holstad S, Lundborg CS. Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residents? A cluster randomized controlled trial. J Antimicrob Chemother. 2011;66:2659–66. The primary outcome of fluoroquinolone use for urinary infection decreased for both intervention and control homes, but there was no difference post-intervention between the two. Overall antimicrobial use and a “wait and see” approach for infection management were significantly improved in intervention homes.PubMedCrossRef
24.
Smithson A, Chico C, Ramos J, et al. Prevalence and risk factors for quinolone resistance among Escherichia coli strains isolated from males with community febrile urinary tract infection. Eur J Clin Microbiol Infect Dis. 2012;31:423–30.PubMedCrossRef
25.
Tinelli M, Cataldo MA, Mantengoli E, et al. Epidemiology and genetic characteristics of extended-spectrum β-lactamase-producing Gram-negative bacteria causing urinary tract infections in long-term care facilities. J Antimicrob Chemother. 2012;67:2982–7.PubMedCrossRef
26.
Neuner EA, Sekeres J, Hall GS, van Duin D. Experience with fosfomycin for treatment of urinary tract infections due to multidrug-resistant organisms. Antimicrob Agents Chemother. 2012;56:5744–8.PubMedCrossRef
27.
Alexander BT, Marschall J, Tibbetts RJ, et al. Treatment and clinical outcomes of urinary tract infections caused by KPC-producing Enterobacteriaceae in a retrospective cohort. Clin Ther. 2012;34:1314–23.PubMedCrossRef
28.
• Tasbakan MI, Pullukcu H, Sipahi OR, Yamazhan T, Ulusoy S. Nitrofurantoin in the treatment of extended-spectrum β-lactamase producing Escherichia coli-related lower urinary tract infection. Int J Antimicrob Agents. 2012;40:554–6. In patients with ESBL producing organisms sensitive to nitrofurantoin isolated from urinary culture, 70 % were cured with nitrofurantoin therapy. Most of these patients had complicated lower urinary tract infection.PubMedCrossRef
Metadata
Title
Issues in the Diagnosis and Management of Urinary Tract Infections in the Older Adult
Author
Lindsay E. Nicolle
Publication date
01-09-2013
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 3/2013
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-013-0046-5

Other articles of this Issue 3/2013

Current Geriatrics Reports 3/2013 Go to the issue

Infectious Diseases in the Elderly (SF Bradley, Section Editor)

Issues Surrounding Antibiotic Use in Older Adults

Infectious Diseases in the Elderly (SF Bradley, Section Editor)

The Epidemiology and Clinical Impact of Surgical Site Infections in the Older Adult

Neurology of Aging (KS Marder, Section Editor)

Vascular Dementia

Infectious Diseases in the Elderly (SF Bradley, Section Editor)

Changing Epidemiology and Control of Clostridium difficile in Older Adults

Infectious Diseases in the Elderly (SF Bradley, Section Editor)

Impact and Management of MRSA in the Long-Term Care Setting

Neurology of Aging (KS Marder, Section Editor)

Primary Central Nervous System Tumors in the Aging Population
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits