Urinary Tract Infection
Pathogenesis Of Bacteriuria, Diagnosis And Management Of Uti
Infections of the urinary tract are the most frequent bacterial infections identified in older adults. The variation in illnesses that these infections produce is quite wide, and can range from bacteria present in the urine without symptoms (asymptomatic bacteriuria) to infections producing chiefly bladder symptoms (symptomatic urinary tract infections, or UTIs) that spread to the blood (sepsis) and can give rise to complications such as shock and even death. The prevalence of both bacteriuria and symptomatic UTI increases with age (Sobel and Kaye). Bacteriuria is present in 20 percent of older women and 10 percent of older men living in the community (Sobel and Kaye). This prevalence increases to 20–25 percent in both sexes residing in long-term care facilities and to 30–50 percent in hospitalized older adults (Baldassare and Kaye). Although most studies have failed to identify an association between bacteriuria or symptomatic UTI and increased overall mortality in older adults, these infections frequently lead to significant morbidity (Baldassare and Kaye; Nicolle, 1992). Urosepsis (infection in the blood stemming from urinary tract) accounts for up to 56 percent of sepsis in older adults, and mortality can be as high as 25 percent (Richardson; Leibovici et al.). Difficulty in distinguishing between asymptomatic bacteriuria and symptomatic UTI in institutionalized older adults often leads to the unnecessary use of antibiotics and diagnostic testing, with the attendant risks.
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