Age-related Trends in Adults with Urinary Tract Infections Presenting to the Emergency Department: A 5-Year Experience

Author(s): Silvia Cardone, Carmine Petruzziello, Alessio Migneco, Barbara Fiori, Teresa Spanu, Tiziana D'Inzeo, Francesco Franceschi, Veronica Ojetti*.

Journal Name: Reviews on Recent Clinical Trials

Volume 14 , Issue 2 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections, affecting 150 million people worldwide each year. Importantly, the incidence of UTI increases markedly with age. The increasing resistance to empirically prescribed antimicrobial agents complicates the management of this disease. This makes UTI an important issue in increasingly aging population and updated epidemiological investigation is advisable.

To understand the epidemiological variation in UTI resistance patterns among differently aged populations, we conducted a retrospective study among patients presenting to the emergency department (ED) of a large tertiary-care hospital in Italy during January 2013 and June 2017.

Methods: 1281 patients who presented with UTI symptoms to the ED, were stratified into four age categories: young adults (18-44 years old;), adults (45-64), the elderly (65-84), and the oldest old (≥ 85). Inclusion criteria were urine collected in ED patients with UTI symptoms and first positive culture from one given patient in a given year.

Results: 362 (28.2%) patients had a urine culture with positive result, leading to a total of 459 germs isolated, stratified into four categories: young adults (58 isolates, 12.6%), adults (98, 21.4%), the elderly (174, 37.9%), and the oldest old (129, 28.1%).

Escherichia coli represents the 60% of all monomicrobial infections, followed in frequency by Klebsiella pneumoniae (15%), and Enterococcus faecalis (5%). The other 20% of the infections are caused by various germs.

The most common association of germs in polymicrobial is E. coli + E. faecalis, accounting for the 28% of all infections.

Overall, we found a peak of susceptibility to amoxicillin (AMX) in the oldest old ( 81%), significantly higher compared to young adults (54%), adults (47%) and elderly (35%) (p<0,001).

For ciprofloxacin (CIP) there is a greater susceptibility in the young adult (55.5%), but not so marked compared to the other three groups; for fosfomicin (FOS) the susceptibility was greater in the group of adults (60%) compared to young adults, elderly and the oldest old. Also for trimethoprim/ sulfamethoxazole (TMP-SMX) we found greater susceptibility in the adult group (60%), followed by the oldest old (57,6%), young adults (49%) and elderly (47%).

Conclusion: Age-related differences in antimicrobial-resistant microorganisms were evident for adults with UTI, and could potentially contribute to the risk of inappropriate empirical therapy in elderly patients. Thus, different empirical antimicrobial regimens should be considered for distinct age groups.

Keywords: Antibiotic resistance, emergency department, urinary tract infections, epidemiological variation, retrospective study, monomicrobial infections.

[1]
Harding GK, Ronald AR. The management of urinary infections: What have we learned in the past decade? Int J Antimicrob Agents 1994; 4: 83-8.
[2]
O’Brien VP, Hannan TJ, Nielsen HV, Hultgren SJ. Drug and vaccine development for the treatment and prevention of urinary tract infections. Microbiol Spectr 2016; 4(1): 1.
[3]
Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Stat 2011; 169: 1-38.
[4]
Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002; 113(Suppl. 1A): 5S-13S.
[5]
Foxman B. Urinary tract infection syndromes: Occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am 2014; 28: 1-13.
[6]
Francis WJA. Disturbances of bladder function in relation to pregnancy. J Obstet Gynaecol Br Emp 1961; 67: 353-65.
[7]
Aslan D, Aslan G, Yamazhan M, Ispahi C, Tinar S. Voiding symptoms in pregnancy: An assessment with international prostate symptom score. Gynecol Obstet Invest 2003; 55: 46-9.
[8]
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 2015; 13(5): 269-84.
[9]
Ronald A. The etiology of urinary tract infection: Traditional and emerging pathogens. Dis Mon 2003; 49(2): 71-82.
[10]
Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002; 287(20): 2701-10.
[11]
Nordmann P, Naas T, Poirel L. Global spread of Carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011; 17(10): 1791-8.
[12]
Meyers BR, Wilkinson P. Clinical pharmacokinetics of antibacterial drugs in the elderly. Implications for selection and dosage. Clin Pharmacokinet 1989; 17(6): 385-95.
[14]
Singh N, Gandhi S, McArthur E, et al. Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women. CMAJ 2015; 187(9): 648-56.
[15]
European Committee on Antimicrobial Susceptibility Testing (2018) Breakpoint tables for interpretation of MICs and zone diameters. Version 8. 0. Available at. http: //www.eucast.org
[16]
Zhang Z. Univariate description and bivariate statistical inference: The first step delving into data. Ann Transl Med 2016; 4(5): 91.
[17]
Ruben FL, Dearwater SR, Norden CW, et al. Clinical infections in the noninstitutionalized geriatric age group: Methods utilized and incidence of infections. The Pittsburgh Good Health Study. Am J Epidemiol 1995; 141(2): 145-57.
[18]
Chu CM, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol 2018; 219(1): 40-51.
[19]
Leoni AF, Monterisi A, Acuña PG. Community acquired urinary tract infections in older adults. Rev Fac Cien Med Univ Nac Cordoba 2017; 74(1): 10-7.
[20]
Ronald A. The etiology of urinary tract infection: Traditional and emerging pathogens. Dis Mon 2003; 49(2): 71-82.
[21]
Aguinaga A, Gil-Setas A, Mazón Ramos A, et al. Uncomplicated urinary tract infections Antimicrobialsusceptibility study in Navarre. An Sist Sanit Navar 2018 30; 41(1): 17-26.
[22]
Linhares I, Raposo T, Rodrigues A, Almeida A. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: A ten-year surveillance study (2000- 2009). BMC Infect Dis 2013 18; 13: 19.
[23]
Bischoff S, Walter T, Gerigk M, Ebert M, Vogelmann R. Empiric antibiotic therapy in urinary tract infection in patients with risk factors for antibiotic resistance in a German emergency department. BMC Infect Dis 2018; 18(1): 56.
[24]
Nelson JM, Good E. Urinary tract infections and asymptomatic bacteriuria in older adults. Nurse Pract 2015; 40(8): 43-8.
[25]
Scholes D, Hooton TM, Roberts PL, et al. Risk factors for recurrent urinary tract infection in young women. J Infect Dis 2000; 182(4): 1177-82.
[26]
Hitzenbichler F, Simon M, Holzmann T, et al. Antibiotic resistance in Escherichia Coli isolates from patients with urinary tract infections presenting to the emergency department. Infection 2018; 46(3): 325-31.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 14
ISSUE: 2
Year: 2019
Page: [147 - 156]
Pages: 10
DOI: 10.2174/1574887114666181226161338
Price: $58

Article Metrics

PDF: 37
HTML: 2