Treatment of urinary tract infections in the old and fragile
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INVITED REVIEW
Treatment of urinary tract infections in the old and fragile Guohua Zeng1 · Wei Zhu1 · Wayne Lam2 · Ayberk Bayramgil3 Received: 27 October 2019 / Accepted: 4 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Urinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population. Methods Pubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed. Results 64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI. Conclusion UTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population. Keywords Urinary infection · Elderly · Frail · Asymptomatic bacteriuria · Review
Introduction Urinary tract infections (UTIs) are extremely common, affecting 150 million people each year worldwide [1]. Frail elderly patients, often associated with a range of disabilities as incontinence, immobility, and cognitive impairment, are at particularly high risk for the development of UTIs [2]. Guohua Zeng and Wei Zhu equally contributed to this work and should be considered as co-first authors. * Guohua Zeng [email protected] 1
Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, Guangdong, China
2
Division of Urology, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
3
Department of Internal Medicine, Istanbul Medipol University, Istanbul, Turkey
This is likely due to the altered physiology in this population that increases their susceptibility to both infection and urinary bacterial overgrowth. UTIs are the leading causes of bacteremia, n
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