Treatment of urinary tract infections in the old and fragile
- 27 March 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in World Journal of Urology
- Vol. 38 (11), 2709-2720
- https://doi.org/10.1007/s00345-020-03159-2
Abstract
Introduction Urinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population. Methods Pubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed. Results 64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI. Conclusion UTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population.Funding Information
- National Natural Science Foundation of China (81870483, 81800625)
- Natural Science Foundation of Guangdong Province (2018A030310296)
This publication has 77 references indexed in Scilit:
- Urine Clarity Inaccurate to Rule Out Urinary Tract Infection in WomenThe Journal of the American Board of Family Medicine, 2011
- Extended-spectrum β-lactamase-producing Gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapyInfection, 2011
- Optimal management of urinary tract infections in older peopleClinical Interventions in Aging, 2011
- Predictive factors of urinary tract infections among the oldest old in the general population. a population-based prospective follow-up studyBMC Medicine, 2011
- Safety Considerations of Fluoroquinolones in the ElderlyDrugs & Aging, 2010
- Antimicrobial Susceptibility of Bacteria Isolated from Urine Samples Obtained from Nursing Home ResidentsInfection Control & Hospital Epidemiology, 2009
- Clinical Features to Identify Urinary Tract Infection in Nursing Home Residents: A Cohort StudyJournal of the American Geriatrics Society, 2009
- Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities: 2008 Update by the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2009
- Asymptomatic bacteriuria in the elderly: High prevalence and high turnover of strainsScandinavian Journal of Infectious Diseases, 2008
- Catheter-Related Urinary Tract InfectionDrugs & Aging, 2005