Do you know these 5 facts about Urinary Tract Infections in the elderly?  The National Center for Biotechnology Information reports that...

1. Urinary tract infections are overdiagnosed and overtreated in older people.
2. Diagnosis of infection of the urinary system in an older person requires the presence of new urinary symptoms.
3. Asymptomatic bacteriuria (ASB) is very common in later life and should not be screened for or treated.
4. Local guidelines and antibiotic policies should be used for management of UTI.
5. Narrow spectrum antibiotics are generally preferable to broad spectrum agents.

Urinary tract infections and kidney infections present a significant problem in both hospital medicine and general practice. The burden of infection is high and there are many challenges in diagnosis and management. Several studies have identified the need for better education on asymptomatic bacteriuria and presentation of UTI in the elderly population. Symptomatic infections are often difficult to diagnose in older populations where there are high levels of cognitive impairment and communication difficulties, such as amongst residents of institutional care.

The strategy of observing patients for possible symptoms BEFORE initiating antibiotics has been advocated, although recognizing it may not be practical in a primary care setting. Reducing inappropriate prescribing of antibiotics for asymptomatic bacteriuria is likely to reduce antimicrobial resistance.

With emerging knowledge on antibiotic resistance of uti-causing bacteria and health care-associated infection, guidelines need to be updated to reflect the need to prescribe narrow spectrum agents when available and avoid empirical use of broad spectrum antibiotics.

Prevention of catheter-associated UTI

Catheter associated UTI is the most common health care associated infection throughout the world and is common in long-term care facilities. Urinary catheterization should be avoided unless there is a clear clinical indication. Catheters should be avoided where possible for the management of incontinence. Staff should also be trained on indications for catheterization and written protocols should be put in place. Catheters should also be removed the moment that they are no longer required.

Alternatives to indwelling urethral catheters should be considered. Condom catheters are associated with a lower incidence of bacteriuria, however their use is sometimes difficult in confused patients.

Guidelines suggest that antibiotic prophylaxis should not be used to prevent catheter associated UTI in catheterized patients. Although prophylaxis may decrease the incidence of asymptomatic bacteriuria in catheterized patients, it increases the risk of antimicrobial resistance.

Prevention of UTI - Cranberry products

Cranberries have long been considered to have a role in reducing UTIs. Cranberries contain tannins called proanthocyanidins, which prevent adherence of P-fimbriated E. coli to uroepithelial cells on the bladder wall.

Increase Mobility

Decreased mobility in aging adults has been shown to increase the risk for hospitalization for UTI. A recent retrospective cohort study by Rogers and colleagues of older adults admitted to a long-term care facility found a significantly lower rate of hospitalization for UTI in patients who were able to walk. In this study, adults older than 65 years who were able to walk independently had a 69% reduction in risk of hospitalization for UTI in comparison with older adults who did not walk or required significant assistance.

Patient Teaching for UTI

Patient teaching includes increasing fluids and vitamin C intake, drinking unsweetened cranberry juice, taking a probiotic and herbal remedies.

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REFERENCES

1. High KP, Bradley SF, Gravenstein S, et al. 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 America. Clin Infect Dis. 2009;48(2):149–71. [PubMed]
2. Juthani-Mehta M, Drickamer MA, Towle V, et al. Nursing home practitioner survey of diagnostic criteria for urinary tract infections. J Am Geriatr Soc. 2005;53(11):1986–90. [PubMed]
3. Stone ND, Ashraf MS, Calder J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33(10):965–77. [PMC free article] [PubMed]
4. Loeb 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(2):120–4. [PubMed]
5. Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643–54. [PubMed]
6. Curns AT, Holman RC, Sejvar JJ, et al. Infectious disease hospitalizations among older adults in the United States from 1990 through 2002. Arch Intern Med. 2005;165(21):2514–20. [PubMed]
7. Caterino JM, Weed SG, Espinola JA, et al. National trends in emergency department antibiotic prescribing for elders with urinary tract infection, 1996–2005. Acad Emerg Med. 2009;16(6):500–7. [PubMed]