urinary tract infection in the elderly

7/26/2019 Urinary Tract Infection in the Elderly

1/18

Urinary Tract Infection in the

Elderly


2/18


3/18


4/18

Risk factors in Elderly

medications:

AH, AntiCh, Anti psychotic, analgeticsdecreasedparasympathetic toneurinary flow decrease, fecalimpactionurinary retention, post void volume incrbacterial colonisation

Behavioral : incontinencepoor hygiene

Physiological : voiding dysfunction (incontinence,increased residual volume, poor hygiene)


5/18


6/18

UTI in...

Elderly

Walking well

With chronicdisease

Institutionalized


7/18

UTI in the Walking Well ElderlyUTI Sign and Symptoms

Urethritis Dysuria, purulent dischargeBacterial Prostatitis Dysuria, frequency,

Suprapubic, pelvic, perineal pain

Fever, malaise

Reccurence rate >50% in

elderly (acute)

Chronic (symptoms > 3mos)

Cystitis Dysuria, urgency, frequency,, F > MF : Poor hygiene

M :Urinary retention (BPH,

bladder enervation)

FR:

DM, Dementia, pelvicrelaxation syndrome

Interstitial Cystitis

(painful bladder

syndrome)

Pelvic pain, urgency, frequency,

without bacteriuria

e/: hormonal ,

radiotherapyaltering

mucosal lining

Honeymoon cystitis ysuria, urgency, frequency,, Folllowing sexua, intercpourse


8/18

UTIs Secondary to Chronic Disease

Due to

Diabetes Mellitus Elderly with DM : 5x increased UTI risk

Asymptomatic bacteriuria + DM needs

special assessment ( risk on UTI in

18months)

Patophysiology

Glycosuriaincreased adherence

of bacteria

Decreased neutrophils function

Pyelonephritis Ascending from lower UTI Fever, nausea, vomiting,

abdominal pain, Flank

pain,

Renal calculi Stoneobstructionstasisinfection

struvite stone

Hyperuricemia, hypercalcemia


9/18

UTI in Institutionalized Elderly

12-30%

increased perineal

colonization, vaginitis, andbacterial colonization in

the bladder.

BPH tendency

Difficult to assesssymptoms

Often complicated byunderlying or chronic

disease

less able to excrete acidand ureafail tomaintain normal

osmolality.


10/18

Additional risk factor:

Decreased cognition + incontinence

bedwetting or soiling, skin breakdown, secondary

infectionplacement of a permanent urinary catheterrisk of urosepsis (bacteremia with systemic infection

and potential vascular collapse).

Urinary catheterization

medications


11/18

Asymptomatic Bacteriuria

50% institutionalizedelderly

almost 100% incatheterized pt.

>100,000 CFU/mlwithout symptoms or

signs

Benign, transient,and does not require

AB.

Some resolvespontaneously, somebecome symptomatic

Therapy is provenineffective in

reducing morbidityand mortality rate.

Screen beforegenitourinary

procedure,

If +Levofloxacin500mg SD PO


12/18


13/18

DIAGNOSING UTI in ELDERLY

UTI criteria for elderly still lacks of agreement


14/18

Diagnosis

history

Burning sensation when voiding, frequency, urgency, bed wetting, fall, fatigue

Difficult to assess due to symptoms overlap, decreased cognitive

PhysicalExamination

Appears ill and distressed Fever or hypothermia might be slight/non

Suprapubic, CVA tenderness, Urethral discharge

Gynecologic exam :Organ prolapse, BPH

lab

UA: proteinuria, RBC, WBC > 10/HRF, nitrit

CBC : leukocytosis

Culture if no progress after 2 days pharmacotherapy


15/18

Culture results


16/18

therapy

Walking well patients:

1stline: Sulfonamid or ampicilin (3d)

2ndline : kuinolon

Prostitis

Acute : kuinolon, sulfa (4-6wk)

Chronic : culutre and sensitivity testAB 12wk

Asymptomatic bacteriuria/funguriano th/


17/18

Conclusion

Various geriatric populations are affected by UTIs.

Each of these populations is impacted in different

ways and requires a different treatment

approach.

Symptoms of UTI in elderly patients may differ

from general population

The treatment must be based on the patient'soverall health, underlying chronic conditions, and

ability to care for himself or herself.


18/18

Thankyou

urinary tract infection in the elderly

Documents