Characteristics of febrile urinary tract infections in older male adults

Abstract

BackgroundUrinary tract infections (UTI) are among the most frequent bacterial infections in older adults. The aim of the study was to analyse the existence of differences in clinical features, microbiological data and risk of infection by multidrug-resistant organisms (MDRO) between older and non-older men with febrile UTI (FUTI).MethodsThis was an ambispective observational study involving older males with a FUTI attended in the Emergency Department. Variables collected included age, comorbidity, diagnostic of healthcare-associated (HCA)-FUTI, clinical manifestations, hospitalization, mortality, and microbiological data.ResultsFive hundred fifty-two males with a FUTI, 329 (59.6%) of whom were older adults, were included. Older males had a higher frequency of HCA-FUTI (p < 0.001), increased Charlson scores (p < 0.001), had received previous antimicrobial treatment more frequently (p < 0.001) and had less lower urinary tract symptoms (p < 0.001). Older patients showed a lower frequency of FUTI caused by E. coli (p < 0.001) and a higher rate of those due to Enterobacter spp. (p = 0.003) and P. aeruginosa (p = 0.033). Resistance rates to cefuroxime (p = 0.038), gentamicin (p = 0.043), and fluoroquinolones (p < 0.001) in E. coli isolates and the prevalence of extended-spectrum beta-lactamase and AmpC producing E. coli and Klebsiella spp. strains (p = 0.041) and MDRO (p < 0.001) were increased in older males. Inadequate empirical antimicrobial treatment (p = 0.004), frequency of hospitalization (p < 0.001), and all cause in-hospital mortality (p = 0.007) were higher among older patients. In the multivariate analysis, being admitted from an long term care facility (OR 2.4; 95% CI: 1.06–5.9), having a urinary tract abnormality (OR 2.2; 95% CI: 1.2–3.8) and previous antimicrobial treatment (OR 3.2; 95% CI: 1.9–5.4) were associated to FUTI caused by MDRO.ConclusionsOlder male adults with a FUTI have different clinical characteristics, present specific microbiological features, and antimicrobial resistance rates. In the multivariate analysis being an older male was not associated with an increased risk of FUTI caused by MDRO.

Characteristics of urinary tract infections in older patients in a tertiary hospital in Greece

“…6 Sepsis and septic shock were the clinical presentation in 47% and 3% respectively, which were similar to other studies. 6,17,18 In our study, concomitant bacteremia was slightly lower than in the literature. 6,18 Notably, in a study that was conducted in our institution in patients with acute pyelonephritis, concomitant bacteremia was noted in 19.4% of patients.…”

“…More specifically, only 20.5% (42 patients) had a blood culture available, so that almost 50% of the blood cultures taken were positive. 6,18 Indeed, in other studies, including both older and younger patients, where blood cultures were taken from every patient, concomitant bacteremia was between 31% and 50% [17][18][19][20] ; however, older patients seemed to be more prone to develop bacteremia, 17 and this is what our study also implies.…”

“…The characteristics of the patients with UTI are shown in Table 1. (19), vancomycin in 8.3% (17), colistin in 3.4% (seven), aminopenicillin in 2% (four), fluconazole in 1.5% (three) and co-trimoxazole in 1% (two). Imaging of the urinary tract was performed in 39.2% (80 patients), which was an ultrasound in 96.3% (77) and computed tomography in 7.5% (six).…”

“…26 Overall mortality in our study was 18%, which was higher than in other studies where mortality was <10%. 6,17,18 Interestingly, a multivariate logistic regression analysis identified revealed sex, dementia, bedridden state, and previous antimicrobial use or hospitalization to be independently associated with mortality. This could also explain the reason why such a high mortality was noted in our study, as our population included a quite higher proportion of patients with dementia, previous hospitalization and patients in a bedridden state with a poor functional status than in other studies.…”

Microbial Resistance in Urinary Tract Infections

“…These difficulties can generate turbulent retrograde urine flow leading to ascending infections. The prostate might be ultimately involved and it becomes a site for multiplication of resistant bacteria [18]. The extendedspectrum of resistance did not explain the sensitivity of E. coli to lactamase inhibitor combinations in drug therapy as well as macrolides and other agents because these species are more than likely to be resistant to the aforementioned drugs.…”