A prospective analysis of urinary tract infections among elderly trauma patients

Abstract

Introduction Catheter-associated urinary tract infections (CAUTI) have been deemed “reasonably preventable” by the Centers for Medicare and Medicaid (CMS) thereby eliminating reimbursement. Elderly trauma patients, however, are at high risk for developing urinary tract infections (UTI) given their extensive comorbidities, immobilization, and environmental changes in the urine which provide the ideal environment for bacterial overgrowth. Whether these patients develop CAUTI as a complication of their hospitalization or have asymptomatic bacteriuria (ASB) or UTI upon admission must be determined in order to justify the “reasonably preventable” classification. We hypothesize that a significant proportion of elderly patients will present with ASB or UTI on admission. Methods IRB permission was obtained to perform a prospective, observational clinical trial of all elderly (≥ 65 years) patients admitted to our Level I Trauma Center as a result of injury. Urinalysis (UA) and culture (UCx) were obtained at admission, 72 hours, and, if diagnosed with UTI, at 2 weeks after injury. Mean cost of UTI was calculated based Center for Disease Control and Prevention estimates of $862 – $1,007 per UTI. Results Of 201 eligible patients, 129 agreed to participate (64%). Mean age was 81±8.6 years. All patients had a blunt mechanism of injury (76% falls) with a mean Injury Severity Score of 13.8±7.6. Of the 18 (14%) patients diagnosed with CAUTI, 14 (78%) were present at admission. Additionally, there were 18 (14%) patients with ASB on admission. The most common bacterial species present on admission urine culture were E. coli (24%) and Enterococcus (16%). Clinical features associated with bacteriuria on admission included a history of UTI, positive gram stain, abnormal microscopy, and pyuria. The estimated loss of reimbursement for 18 UTIs on admission was $15,516 – $18,126; however, given an estimated cost of $1981 to screen all patients with UA and UCx at admission, up to $16,144 savings was realized. Conclusion Many elderly trauma patients present with UTI. Screening UA and UCx on admission for elderly trauma patients identifies these UTIs and is cost-effective.

Similar Neutrophil-Driven Inflammatory and Antibacterial Responses in Elderly Patients with Symptomatic and Asymptomatic Bacteriuria

“…As part of an observational trial of 129 elderly patients (Ն65 years old) admitted to the hospital following accidental injury, most of whom were catheterized on admission, urine sediments were examined to determine whether undiagnosed UTI and ASB potentially contributed as causes of the trauma suffered. We previously reported that 25% of the cases examined by urinalysis and urine culture showed evidence of bacteriuria on admission (24), suggesting that the rationale to declare CAUTI a preventable disease in the nosocomial environment is confounded by preexisting bacteriuria in elderly patients (8). Here, we analyzed the metaproteome of 100 urinary sediment samples from all patients with evidence of bacteriuria and 12 patients with negative UC test results.…”

“…The Internal Review Boards of the Mayo Clinic and the J. Craig Venter Institute (JCVI) approved the human subject protocol and the consent forms in application no. 12-010185 (24). All patients had a blunt mechanism of injury, with falls from a standing height in 76% of the cases.…”

Urinary Tract Infection Management in Elderly People : Approach Beyond the Pills and Needles

“…As long-term catheters play a fundamental role in contracting UTI in elderly patients, it should only be reserved for serious urinary retention conditions like the neurogenic bladder, etc 20 . People with poor health status should be given more attention, and sudden instability of the patient must be evaluated cautiously and should be treated promptly to prevent any unfortunate consequences [19][20][21][22][23][24] . Health professionals should be trained up adequately to take care of these conditions ensuring the delivery of high-quality healthcare for elderly patients suffering from UTI.…”

“…Conditions like the kidney stone, diverticula and stricture should be investigated properly to avoid further complication 21,22 . For diabetic patients, blood glucose will regularly be monitored, and the appropriate drug should be given as blood sugar increases the risk of relapse and reinfection 23 . Patients on immunosuppressive agents also demand particular attention in this regard 23,24 .…”

Is Urinary Tract Infection Different in Elderly and Adults Aged Under 65 Years? Ege University Experience

“…Tüm yaşlarda ÜSE etkenleri arasında en sık karşılaşılanlar E. coli başta olmak üzere Klebsiella spp., Proteus mirabilis, Pseudomonas spp., diğer Gram-olumsuz bakteriler, Staphylococcus saphrophyticus ve enterokoklardır [12] . İleri yaş travma hastalarında gelişen ÜSE'lerin değerlendirildiği prospektif bir çalışmada E. coli ve enterokoklar en sık saptanan etkenler olarak bildirilmiştir [13] . Çalışmamızda ise en sık karşılaşılan etkenler E. coli, K. pneumoniae ve enterokoklardır.…”