Urinary Tract Infections (UTIs)

UTIs become increasingly common in the elderly, especially in institutionalized patients and those with chronic indwelling urinary catheters. It is not necessary to treat asymptomatic bacteriuria. Urinary tract infections may precipitate urinary incontinence in a person with preexisting urinary tract abnormalities but usually not in someone with normal urinary tract function. The presenting symptoms of a UTI may be nonspecific increasing confusion, anorexia, incontinence, or falls are all possible. Fever and dysuria may not be present; however, when fever is present in an elderly patient, UTI is a common cause.

The most common organisms are gram-negative bacilli, with E. coli as a cause in as many as 80% of community dwelling non-catheterized patients. Polymicrobial and gram positive infections are more common in men and patients with chronic indwelling catheters. Mortality is higher in patients with catheters, in those from nursing homes, and in those with gram-positive organisms; this and probably reflects in large part the presence of comorbidity in those patients.

Management may begin before culture results are available. The choice between oral or IV treatment will depend on the symptoms and underlying condition of the patient. The initial treatment should usually be a broad spectrum antibiotic. TMP/SMX is a commonly used oral antibiotic, and cephalosporins are commonly used intravenous antibiotics. The exact choice will be based on the local patterns of bacterial isolates. Once the culture results are known, treatment may be changed to a better targeted antibiotic.