Urinary Tract Infections in Older Adults: Current Issues and New Therapeutic Options

Sophie Robichaud, MD, FRCP(C); Joseph M. Blondeau, MSc, PhD, RSM(CCM), SM(AAM), SM(ASCP), FCCP

Disclosures

Geriatrics and Aging. 2008;11(10):582-588. 

In This Article

Abstract and Introduction

Urinary tract infections (UTIs) are the most common infectious problem among older adults both in the community and institutional settings. With the expected increase in this population, UTI-related costs—both human and financial—will rise in a parallel fashion. The diagnosis of symptomatic UTI among older adults is complicated by the high prevalence of asymptomatic bacteriuria, which does not require any treatment, and the difficulty in interpreting the signs and symptoms of UTI in a population in which significant comorbidities can undermine the communication between the patient and the medical team. Another important issue is the constant increase in antimicrobial resistance, especially in long-term care facilities, where antimicrobial use is greater than in the community. Newer agents are now available for the treatment of UTI among older adults, targeting both the usual and the multiresistant uropathogens. Rational use of antimicrobials in the treatment of UTI in the older adult is important to both provide appropriate care and control the spread of resistant organisms in this population.

Symptomatic urinary tract infection (UTI) is considered the most important bacterial infection in the general population. The financial implications for the health care system are staggering: more than US$2 billion annually for the total cost of both community- and hospital-acquired infections in the U.S. alone.[1] Among the populations at special risk for UTI are older adults. For older adults living in a community setting, it is the second most common infection diagnosed.[1] In long-term care (LTC) facilities, UTIs are consistently reported as the leading site of infection. The prevalence of bacteriuria in patients without an indwelling catheter is between 25% and 50% for women and 15% and 40% for men, and the rate of symptomatic infection with fever for both males and females is between 0.046 and 0.126 per 1,000 patients-days in an LTC facility.[2,3]

The purpose of this article is to review the particular characteristics of UTI among older adults, including the diagnostic challenges presented to the clinician in this particular setting. Other important topics include the microbiology of UTI in this population and some recent additions to the antimicrobial armamentarium available for its treatment.

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