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

Abstract

Aims Urinary tract infections (UTIs) are commonly encountered. They are more commonly caused by Enterobacteriaceae, while antimicrobial resistance is an emerging problem in their management, with extended‐spectrum‐β‐lactamase (ESBL) producing Gram‐negative bacteria and multidrug‐resistant (MDR) Pseudomonas aeruginosa being increasingly common. The purpose of this study was to investigate the epidemiology and outcomes of UTIs in patients admitted in a tertiary hospital, which mostly admits geriatric patients, and compare the effects of antimicrobial resistance on patient outcomes. Methods A retrospective observational study was conducted at a University Hospital in Crete, Greece. Epidemiology and clinical characteristics of patients with a UTI were recorded. Results During the 3‐year period of the study, 204 UTIs were recorded. Mean age was 83.3 years and 38.7% were male. The most common isolated pathogens were Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis. Among all patients with UTI, 15.7% had an infection from ESBL, MDR, extensively drug‐resistant or vancomycin‐resistant enterococci pathogens. Recent antimicrobial use or hospitalization, dementia, bedridden state and sex were independently associated with mortality, while being a nursing home resident was independently associated with a higher possibility of infection from ESBL, MDR, extensively drug‐resistant or vancomycin‐resistant enterococci pathogens. Infection by such a resistant pathogen led to increased duration of hospitalization but not to increased mortality. Conclusions Alarming antimicrobial resistance rates were noted in patients with UTIs, and this led to longer duration of hospitalization even though it did not have an impact on mortality, which was otherwise higher than in other studies. Geriatr Gerontol Int 2020; 20: 1228–1233.

Urinary Tract Infections in Elderly Patients: A 10-Year Study on Their Epidemiology and Antibiotic Resistance Based on the WHO Access, Watch, Reserve (AWaRe) Classification

“…Elderly persons (aged 65 or over) are at higher risk for developing UTIs, due to a range of intrinsic and extrinsic risk factors, and they often delay seeking treatment. Intrinsic risk factors include age-related immunological senescence and the presence of underlying conditions leading to immunosuppression (e.g., Type II diabetes, malignancy), urinary incontinence, benign prostate hyperplasia, malnourishment and immobility, while extrinsic risk factors include hospitalization, urinary catheterization and chemotherapy [ 18 , 19 ]. The treatment of UTIs in elderly and frail individuals is further hindered as the use of many antimicrobial groups is discouraged, due to their debilitating adverse events and the pathophysiological features (such as decreased kidney and liver function) of these patients [ 20 ].…”

Rectal Colonization by Drug Resistant Bacteria in Nursing Home Residents in Crete, Greece

“…Their mean age was 82.1 years and 19.7% were males (27 residents). The most common underlying medical conditions were neurological diseases (dementia and Parkinson's disease) in 78.8% (108 residents), arterial hypertension in 43.8% (60), diabetes mellitus in 19.7% (27) and congestive heart failure in 7.3% (10). Urinary catheter was present in 5.1% (7 residents), and 3.6% (5) had decubitus ulcers.…”

“…Indeed, high rates of carbapenem resistance have been shown during the last 20 years in Greece, with the induction of multiple mechanisms of resistance such as the Verona Integron-encoded Metallo-beta-lactamase (VIM)-producers or Oxacillinase (OXA)-48-carbapenemase that have important implications on mortality [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Furthermore, there are studies suggesting that there is an increasing prevalence of infections by MDR-GNB microorganisms in geriatric patients in particular [ 27 ]. This makes obvious the necessity for developing countermeasures to reduce the spread of MDR-GNB.…”

Enterobactérias produtoras de ESBL isoladas de uroculturas de pacientes ambulatoriais

“…Esses resultados apresentam números mais elevados que os obtidos por Agegnehu et al (2020) em crianças na Etiópia, sendo que, dentre as Enterobacteriaceae, a maior frequência foi de E. colli com 44,4% e K. penumoniae com 27,8%. Os índices podem, no entanto, variar já que, em idosos na Grécia, Ioannou et al (2020) encontrou um percentual de 40,5% para E. coli e 13,7% para K. pneumoniae, mas, observa-se que em ambos os estudos citados as espécies dos principais patógenos coincidem. Do total de uroculturas positivas, 72,2 % (n=710) foram realizadas em regime particular e 27,8% (n=274) em regime público (SUS).…”

“…Em relação a faixa etária, a maioria com idade acima de 60 anos (60%/n=21). Ioannou et al (2020) encontrou um percentual ainda maior de pacientes do sexo feminino entre para pacientes idosos com infecções do trato urinário, sendo 61,3%. É normal que mulheres por terem uretra mais curta que homens, estejam mais propensas a desenvolver ITU.…”