Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection
Introduction
In older people, the most common bacterial infection is urinary tract infection (UTI), which appears as the most common cause of sepsis in this population. It is also the most common cause of fever in patients hospitalized because of acute febrile disease.1., 2., 3.
The clinical presentation of UTI in the elderly patients is variable, ranging from asymptomatic to septicaemia. Although most infections are asymptomatic or mild and are managed in outpatient, these infections can also be devastating resulting in sepsis and death.
Bacteremic UTI carries with it a mortality rate of 25–60%.1., 4., 5. When possible urosepsis is suspected in older patients, immediate decisions regarding appropriate antibiotic choice must be made. Instituting broad-spectrum coverage with one or more antibiotic is usually recommended.6., 7. Another problem in the choice of empiric antibiotic treatment is the increasing resistance of uropathogens to common antibiotic drugs.
In this retrospective study, we reviewed the records of 191 consecutive febrile patients over 75 years old with simultaneously positive urine and blood cultures for the same organism, who were seen in our hospital over a 29-month period, from January 1998 to May 2000. Clinical and laboratory findings were correlated with the outcome in order to identify independent predictors of mortality.
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Material and methods
The study took place at the Subacute Department of Geriatric Hospital (a 300-bed community hospital) affiliated to a General Hospital. The majority of the patients in this department are admitted from the emergency room of the General Hospital. We reviewed the hospital records of all the patients, 75 years and older with fever over 38 °C, who were diagnosed as bacteremic UTI, which was diagnosed when the same organism was isolated from both urine and blood of the same patient within 48 h of
Results
We identified a total of 191 patients with positive blood and urine cultures for the same organism.
Discussion
UTI remains a significant cause of morbidity in all age groups and is the most frequent cause of sepsis in older adults.8 Several earlier studies have investigated bacteraemias in older patients. In these studies, UTI is the most commonly identified single source of bacteraemia responsible for 32% of the community-acquired bacteraemias and for 40% of the nosocomial bacteraemias with a single identifiable source.9., 10., 11. Bacteremic UTI have been described in relation to the specific places
References (20)
- et al.
Bloodstream infections in the elderly
Am J Med
(1989) - et al.
Urinary tract infections in the critically ill patient with a urinary catheter
Am J Surg
(1999) - et al.
Four-year prospective evaluation of community-acquired bacteremia: epidemiology, microbiology, and patient outcome
Diagn Microbiol Infect Dis
(2001) - et al.
Roles of host and bacterial virulence factors in the development of upper urinary tract infection caused by Escherichia coli
Am J Kidney Dis
(2002) - et al.
Bacteremic urinary tract infection in older people
JAGS
(1996) - et al.
Towards improved empiric management of moderate to severe urinary tract infection
Arch Inter Med
(1992) - et al.
Management of complicated urinary infection in older patients
J Am Geriatr Soc
(1996) Urinary tract infection
Clin Geriatr Med
(1992)- et al.
Management of urinary tract infection in adults
N Engl J Med
(1993) Unique aspects of urinary tract infections in the geriatric population
Gerontology
(1984)
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