Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-20T06:37:30.679Z Has data issue: false hasContentIssue false
  • English
  • Français

Urinary tract infections in older people

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  01 May 2008

Lindsay E Nicolle
Lindsay E Nicolle*
Affiliation:
University of Manitoba, Winnipeg Manitoba, Canada
*
Address for correspondence: LE Nicolle, University of Manitoba Health Sciences Center, 820 Sherbrooke St, Room GG443, Winnipeg, Manitoba, Canada.
Get access Rights & Permissions [Opens in a new window]

Extract

Urinary tract infection is the most common bacterial infection in older populations. It is an important clinical problem across the full spectrum – from elderly persons who are well and living in the community to highly functionally impaired residents of long-term care facilities. Symptomatic urinary infection is a frequent cause of morbidity, and urinary infection is responsible for substantial antimicrobial use. This review summarizes current knowledge relevant to both asymptomatic and symptomatic urinary infection in older populations, and identifies unresolved issues for further study. The discussion is relevant to older individuals without indwelling urethral catheters, unless it is specifically stated that the older person with an indwelling catheter is being addressed.

Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 18 , Issue 2 , May 2008 , pp. 103 - 114
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Nicolle, LE, Bradley, S, Colgan, R, Rice, JC, Schaeffer, A, Hooton, TM. IDSA guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40: 643–54.CrossRefGoogle Scholar
2Jackson, SL, Boyko, EJ, Scholes, et al. Predictors of urinary tract infection after menopause: a prospective study. Am J Med 2004; 117: 903–11.Google Scholar
3Raz, R, Gennesin, Y, Wasser, J et al. Recurrent urinary tract infections in post-menopausal women. Clin Infect Dis 2000; 30: 152–56.CrossRefGoogle Scholar
4Vogel, T, Verreault, R, Gourdeau, M et al. Optimal duration of antimicrobial therapy for uncomplicated urinary tract infection in older women: a double-blind, randomized controlled trial. Can Med Assoc J 2004; 170: 469–73.Google Scholar
5Rodhe, N, Molstad, S, Englund, L, Svardsudd, K. Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics, and associated factors. Fam Pract 2006; 23: 303–07.CrossRefGoogle Scholar
6Rodhe, N, Lofgren, S, Matussek, A et al. Asymptomatic bacteriuria in the elderly: high prevalence and high turnover of strains. Scand J Infect Dis 2008; 40: 804–10.CrossRefGoogle ScholarPubMed
7Mims, AD, Norman, DC, Yamamura, RH, Yoshikawa, TT. Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings. J Am Geriatr Soc 1990; 38: 1209–14.Google Scholar
8Griebling, TL. Urologic Diseases in America Project. Trends in resource use for urinary tract infections in men. J Urol 2005; 173: 1288–94.CrossRefGoogle ScholarPubMed
9Nicolle, LE, Friesen, D, Harding, GKM et al. Hospitalization from acute pyelonephritis in Manitoba, Canada, during the period 1989–992. Impact of diabetes, pregnancy, and aboriginal origin. Clin Infect Dis 1996; 22: 1051–56.CrossRefGoogle ScholarPubMed
10Foxman, B, Klemstein, KL, Brown, PD. Acute pyelonephritis in US hospitals in 1997: Hospitalization and in-hospital mortality. Ann Epidemiol 2003; 13: 144–50.Google Scholar
11Hedin, K, Petersson, Wideback K, Kahlmeter, G, Molstad, S. Asymptomatic bacteriuria in a population of elderly in municipal institutional care. Scand J Prim Health Care 2002; 20: 166–69.CrossRefGoogle Scholar
12Nicolle, LE, Strausbaugh, LJ, Garibaldi, RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996; 9: 1–17.CrossRefGoogle ScholarPubMed
13Stevenson, KB, Moore, J, Colwell, H, Sleeper, B. Standardized infection surveillance in long-term care: interfacility comparisons from a regional cohort of facilities. Infect Control Hosp Epidemiol 2005; 26: 231–38.CrossRefGoogle ScholarPubMed
14Mylotte, JM, Tayara, A, Goodnough, S. Epidemiology of bloodstream infection in nursing-home residents: evaluation in a large cohort from multiple homes. Clin Infect Dis 2002; 35: 148–90.CrossRefGoogle Scholar
15Foxman, B, Somsel, P, Tallman, P et al. Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors. J Clin Epidemiol 2001; 54: 710–18.Google Scholar
16Stern, JA, Hsieh, V-C, Schaeffer, AJ. Residual urine in an elderly female population: novel implications for oral estrogen replacement and impact on recurrent urinary tract infection. J Urol 2004; 171: 768–70.Google Scholar
17Pabich, WL, Fihn, SD, Stamm, WE, Scholes, D, Boyko, EJ, Gupta, K. Prevalence and determinants of vaginal flora alterations in postmenopausal women. J Infect Dis 2003; 188: 1054–55.CrossRefGoogle ScholarPubMed
18Burton, JP, Reid, G. Evaluation of the bacterial vaginal flora of 20 postmenopausal women by direct (Nugent Score) and molecular (polymerase chain reaction and denaturing gradient gel electrophoresis) techniques. J Infect Dis 2002; 186: 1770–70.CrossRefGoogle ScholarPubMed
19Raz, R, Stamm, W. A controlled trial of intra-vaginal estriol in post-menopausal women with recurrent urinary tract infections. N Engl J Med 1993; 329: 753–55.CrossRefGoogle Scholar
20Eriksen, B. A randomized, open, parallel group study on the preventive effect of an estriol-releasing vaginal rink (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol 1999; 180: 1072–79.Google Scholar
21Hu, KK, Boyko, EJ, Scholes, D et al. Risk factors for urinary tract infections in postmenopausal women. Arch Intern Med 2004; 164: 989–83.Google Scholar
22Orlander, JD, Jick, SS, Dean, AD, Jick, H. Urinary tract infection and estrogen use in older women. J Am Soc 1992; 40: 817–10.Google ScholarPubMed
23Brown, JS, Vittinghoff, E, Kanaya, AM et al. Urinary tract infections in post-menopausal women: effect of hormone therapy and risk factors. Obstet Gynecol 2001; 98: 1045–52.Google Scholar
24Schaeffer, AJ. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med 2006; 355: 1690–99.Google Scholar
25Ouslander, JG, Greendale, GA, Uman, G, Lee, C, Paul, W, Schnelle, J. Effects of oral estrogen and progestin on the lower urinary tract among female nursing home residents. J Amer Geriatr Soc 2001; 49: 803–XX0.Google Scholar
26Maloney, C, Oliver, ML. Effect of local conjugated estrogens on vaginal pH in elderly women. J Am Med Dir Assoc 2001; 2: 51–55Google Scholar
27Barabas, G, Molstad, S. No association between elevated post-void residual volume and bacteriuria in residents of nursing homes. Scand J Prim Health Care 2005; 23: 52–55.CrossRefGoogle ScholarPubMed
28Omli, R, Skotnes, LH, Mykletun, A, Bakke, AM, Kuhry, E. Residual urine as a risk factor for lower urinary tract infection: A 1-year follow-up study in nursing homes. J Am Soc 2008; 56: 871–74.Google Scholar
29Ouslander, JG, Greengold, B, Chen, S. External catheter use and urinary tract infection among incontinent male nursing home patients. J Amer Ger Soc 1987; 35: 1063–66.Google Scholar
30Boyko, EJ, Fihn, SD, Scholes, D, Chen, C-L, Normand, EH, Yarbro, P. Diabetes and the risk of acute urinary tract infection among postmenopausal women. Diabetes Care 2002; 25: 1778–77.CrossRefGoogle ScholarPubMed
31Cornia, PB, Takahashi, TA, Lipsky, BA. The microbiology of bacteriuria in men: a 5-year study at Veterans' Affairs hospital. Diag Microbiol Infect Dis 2006; 56: 25–30.CrossRefGoogle Scholar
32Sogaard, M, Schonheyder, HC, Riis, A, Sorensen, HT, Norgaard, M. Short-term mortality in relation to age and comorbidity for older adults with community-acquired bacteremia: a populaton-based cohort study. J Am Ger Soc 2008; 56: 1593–1600.Google Scholar
33Muder, RR, Brennen, C, Wagener, MM, Goetz, AM. Bacteremia in a long-term care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis 1992; 14: 647–44.CrossRefGoogle Scholar
34Wright, SW, Wrenn, KD, Haynes, ML. Trimethoprim/sulfamethoxazole resistance among urinary coliform isolates. J Gen Intern Med 1999; 14: 606–09.CrossRefGoogle ScholarPubMed
35Colodner, R, Kometiani, I, Chazan, B, Raz, R. Risk factors for community-acquired urinary tract infection due to quinolone resistant E. coli. Infection 2008; 36: 41–45.Google Scholar
36Bentley, DW, Bradley, S, High, K, Schoenbaum, S, Taler, G, Yoshikawa, TT. Practice guideline for evaluation of fever and infection in long-term care facilities. Clin Infect Dis. 2000; 31: 640–53.CrossRefGoogle ScholarPubMed
37Boscia, JA, Kobasa, WD, Abrutyn, E, Levison, ME, Kaplan, AM, Kaye, D. Lack of association between bacteriuria and symptoms in the elderly. Am J Med 1986; 81: 979–82.Google Scholar
38Ouslander, JG, Shapira, M, Schnelle, JF. Does eradicating bacteriuria affect the severity of chronic incontinence in nursing home residents? Ann Intern Med 1995; 122: 749–54.CrossRefGoogle ScholarPubMed
39Orr, P, Nicolle, LE, Duckworth, H et al. Febrile urinary infection in the institutionalized elderly. Am J Med 1996; 100: 71–77.Google Scholar
40Nicolle, LE. Consequences of asymptomatic bacteriuria in the elderly. Int J Antimicrob Agents 1994; 4: 107–12.Google Scholar
41Loeb, M, Bentley, DW, Bradley, S et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001; 22: 120–24.CrossRefGoogle ScholarPubMed
42Loeb, M, Brazil, K, Lohfeld, L et al. Effect of a multifaceted intervention on the number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomized controlled trial. BMJ 2005; 331 (7518):669. Epub 2005 Sept 8.Google Scholar
43Gomolin, IH, Siami, PF, Reuning-Scherer, J, Haverstock, DC, Heyd, A. Efficacy and safety of oral ciprofloxacin suspension versus trimethoprim-sulfamethoxazole oral suspension for treatment of older women with acute urinary tract infection. J Am Ger Soc 2001; 49: 1606–03.Google Scholar
44Warren, JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am 1997; 11: 609–02.CrossRefGoogle ScholarPubMed
45Nicolle, LE. The chronic indwelling catheter and urinary infection in long-term care facility residents. Infect Control Hosp Epidemiol 2001; 22: 316–11.Google Scholar
46Rudman, D, Hontanosas, A, Cohen, Z, Mattson, DE. Clinical correlates of bacteremia in a Veterans' Administration extended care facility. J Am Soc 1988; 36: 726–22.Google Scholar
47Saint, S, Chenoweth, CE. Biofilm and catheter-associated urinary tract infections. Infect Dis Clin North Am 2003; 17: 411–12.Google Scholar
48Raz, R, Schiller, D, Nicolle, LE. Chronic indwelling catheter replacement prior to antimicrobial therapy for symptomatic urinary infection. J Urol 2000; 164: 1254–58.Google Scholar
49Nicolle, LE, SHEA, Long-Term Care Committee. Urinary tract infections in long-term care facilities. Infect Control Hosp Epidemiol 2001; 22: 167–75.CrossRefGoogle ScholarPubMed
50Warren, JW, Tenney, JH, Hoopes, JM, Marcie, HL, Anthony, WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982; 146: 719–23.Google Scholar