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Complicated Urinary Tract Infection in the Geriatric Population

  • Infectious Diseases in the Elderly (KS Kaye and D Kaye, Section Editors)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Complicated urinary tract infection (UTI) is a common problem in the geriatric population. The major complicating factors are frequent use of indwelling catheters and disorders that inhibit complete emptying of the bladder. Infection with antimicrobial-resistant, gram-negative bacilli (GNB) is much more common in those with complicated infection than those with uncomplicated infection. Nitrofurantoin and fosfomycin are the oral agents most likely to retain activity against the very resistant GNB, but Proteus species and Pseudomonas are resistant to nitrofurantoin. The polymyxins and tigecycline are the parenteral agents most likely to retain activity against these organisms, but low serum and urine levels are problematic for tigecycline. Bacteremia is common and the infection may be life-threatening in the presence of pyelonephritis with obstructive uropathy, renal abscess, perinephric abscess, emphysematous pyelonephritis, or emphysematous cystitis. With complicated pyelonephritis, imaging studies are critical and urological consultation and intervention may be necessary, especially if obstructive uropathy or any of the above life-threatening complications is present. With complicated lower tract infection, the goal is relief of symptoms.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Marwick CA, Nathwani D. Editorial commentary: linking process measures to outcome for patients with complicated urinary tract infection: it's complicated. Clin Infect Dis. 2014;58:170–2.

    Article  PubMed  Google Scholar 

  2. Cai T, Mazzoli S, Mondaini N, et al. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis. 2012;55:771–7. This paper demonstrates that treatment of asymptomatic bacteriuria results in an increase in symptomatic infection.

    Article  PubMed  Google Scholar 

  3. Drekonja DM, Zarmbinski B, Johnson JR. Preoperative urine cultures at a veterans affairs medical center. JAMA Intern Med. 2013;173:71–2.

    Article  PubMed  Google Scholar 

  4. Olson ES, Cookson BD. Do antimicrobials have a role in preventing septicaemia following instrumentation of the urinary tract. J Hosp Infect. 2000;45:85–97.

    Article  CAS  PubMed  Google Scholar 

  5. Levison ME, Kaye D. Treatment of complicated urinary tract infections with an emphasis on drug-resistant gram-negative uropathogens. Curr Infect Dis Rep. 2013;15:109–15.

    Article  PubMed  Google Scholar 

  6. Mazzulli T. Diagnosis and management of simple and complicated urinary tract infections (UTIs). Can J Urol. 2012;19 Suppl 1:42–8.

    PubMed  Google Scholar 

  7. Chenoweth CE, Gould CV, Saint S. Diagnosis, management and prevention of catheter –associated urinary tract infections. Infect Dis Clin N Am. 2014;28:105–19. This paper is a good review of catheter-associated urinary tract infection and its management. This is one of the most common causes of complicated urinary tract infection in the elderly.

    Article  Google Scholar 

  8. Dielubanza EJ, Mazur DJ, Schaeffer AJ. Management of non-catheter-associated complicated urinary tract infection. Infect Dis Clin N Am. 2014;28:121–34. This paper reviews the management of complicated urinary tract infections from the urological point of view. Areas such as urinary obstruction and renal abscess are covered.

    Article  Google Scholar 

  9. Stickler DJ. Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done. J Intern Med. 2014. doi: 10.1111/joim.12220. [Epub ahead of print]

  10. Nicolle LE. Urinary tract infections in special populations. Infect Dis Clin N Am. 2014;28:91–104. This paper covers the complications associated with diabetes in urinary tract infections including abscesses and emphysematous urinary tract infections.

    Article  Google Scholar 

  11. Frimodt-Møller N. The frequencies of both urinary tract infection and asymptomatic bacteriuria increase with age. Ugeskr Laeger. 2013;175:2868–9.

    PubMed  Google Scholar 

  12. Mnif MF, Kamoun M, Kacem FH, et al. Complicated urinary tract infections associated with diabetes mellitus: pathogenesis, diagnosis and management. Indian J Endocrinol Metab. 2013;17:442–5.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Spoorenberg V, Prins JM, Opmeer BC et al. The additional value of blood cultures in patients with complicated urinary tract infections. Clin Microbiol Infect. 2013. doi: 10.1111/1469-0691.12491. [Epub ahead of print]). This paper stresses the importance of blood cultures in sick hospitalized catheterized patients. The blood culture may yield a different organism than the urine, especially when antibiotics have been started before urine cultures were obtained.

  14. Beerepoot MA, den Heijer CD, Penders J, et al. Predictive value of E. coli susceptibility in strains causing asymptomatic bacteriuria for women with recurrent symptomatic urinary tract infections receiving prophylaxis. Clin Microbiol Infect. 2012;18:E84–90.

    Article  CAS  PubMed  Google Scholar 

  15. Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013;34:1–14. This paper provides data on the antimicrobial susceptibilities of bacteria isolated from catheters of patients in ICUs in the US.

    Article  PubMed  Google Scholar 

  16. Cappuccino L, Bottino P, Torricella A, et al. Nephrolithiasis by Corynebacterium urealyticum infection: literature review and case report. J Nephrol. 2014;27(2):117–25. doi:10.1007/s40620-014-0064-1. Epub 2014 Feb 22.

    Article  PubMed  Google Scholar 

  17. Cattoir V. Actinobaculum schaalii: review of an emerging pathogen. J Infect. 2012;64:260–7.

    Article  PubMed  Google Scholar 

  18. Ranjan KP and Ranjan N. Complicated urinary tract infection caused by extended spectrum β-lactamase-producing Escherichia coli Urol Ann. 2014; 6: 112–3. Urol Ann. 2014;6(2):107-12. doi: 10.4103/0974-7796.130536.

  19. Doi Y, Park YS, Rivera JL, et al. Community-associated extended-spectrum beta-lactamase-producing E. coli in the United States. Clin Infect Dis. 2013;56:641–8.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Vital signs: carbapenem-resistant Enterobacteriaceae. MMWR 2013;62:175-70.

  21. Picozzi SC, Casellato S, Rossini M, et al. Extended-spectrum beta-lactamase-positive Escherichia coli causing complicated upper urinary tract infection: urologist should act in time. Urol Ann. 2014;6(2):107–12. doi:10.4103/0974-7796.130536.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Taneja N, Singh G, Singh M, et al. High occurrence of blaCMY-1 Amp. lactamase producing Escherichia coli in cases of complicated urinary tract infection (UTI) from a tertiary health care centre in north India. Indian J Med Res. 2012;136:289–91.

    PubMed Central  PubMed  Google Scholar 

  23. Qiao LD, Chen S, Yang Y, et al. Characteristics of urinary tract infection pathogens and their in vitro susceptibility to antimicrobial agents in China: data from a multicenter study. BMJ. 2013;3(12):e004152. doi:10.1136/bmjopen-2013-004152.

    Article  Google Scholar 

  24. Peirano G, Pitout JD. Molecular epidemiology of Escherichia coli producing CTX-M beta-lactamases: the worldwide emergence of clone ST131 O25:H4. Int J Antimicrob Agents. 2010;35:316–21.

    Article  CAS  PubMed  Google Scholar 

  25. Martinez P, Garzón D, Mattar S. CTX-M-producing Escherichia coli and Klebsiella pneumoniae isolated from community-acquired urinary tract infections in Valledupar, Colombia. Braz J Infect Dis. 2012;16:420–5.

    Article  CAS  PubMed  Google Scholar 

  26. Foxman B. Editorial commentary: extended-spectrum beta-lactamase-producing E. coli in the United States; time to rethink empirical treatment for suspected E.coli infections? Clin Infect Dis. 2013;56:649–51. This editorial discusses the problem of community-acquired antimicrobial-resistant urinary tract infections.

    Article  PubMed  Google Scholar 

  27. Gupta K. Management of urinary tract infections from multidrug-resistant organisms. Infect Dis Clin N Am. 2014;28:49–59. This paper discusses the management of urinary tract infections caused by antimicrobial resistant bacteria.

    Article  Google Scholar 

  28. Huttner B, Jones M, Rubin MM, et al. Drugs of last resort? The use of polymyxins and tigecycline at US veterans affairs medical centers, 2006-2010. PLoS One. 2012;7:e36649.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Gleckman R, Blagg N, Hibert D, et al. Acute pyelonephritis in the elderly. South Med J. 1982;75:551–4.

    Article  CAS  PubMed  Google Scholar 

  30. Koningstein M, van der Bij AK, de Kraker ME, et al. Recommendations for the empirical treatment of complicated urinary tract infections using surveillance data on antimicrobial resistance in the Netherlands. PLoS One. 2014;9:e86634.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103–20.

    Article  PubMed  Google Scholar 

  32. Pogue JM, Lee J, Marchaim D, et al. Incidence of and risk factors for colistin-associated nephrotoxicity in a large academic health system. Clin Infect Dis. 2011;53:879–84.

    Article  CAS  PubMed  Google Scholar 

  33. Cai Y, Wang R, Liang B, et al. Systematic review and meta-analysis of the effectiveness and safety of tigecycline for treatment of infectious disease. Antimicrob Agents Chemother. 2011;55:1162–72.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. FDA, Drug Safety Communication - Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections. 2010, FDA.

  35. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–63.

    Article  PubMed  Google Scholar 

  36. Harrod M, Kowalski C, Saint S, et al. Variation in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic. BMC Health Serv Res. 2013;13:151.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Neuner EA, Sekeres J, Hall GS, et al. Experience with Fosfomycin for treatment of urinary tract infections due to multidrug-resistant organisms. Antimicrob Agents Chemother. 2012;56:5744–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Auer S, Wojna A, Hell M. Oral treatment options for ambulatory patients with urinary tract infections caused by extended-sprectrum-beta-lactamase-producing E. coli. Antimicrob Agents Chemother. 2010;54:4006–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Reffert JL, Smith WJ. Fosfomycin for the Treatment of Resistant Gram-Negative Bacterial Infections: Insights from the Society of Infectious Diseases Pharmacists.Pharmacotherapy. 2014. doi: 10.1002/phar.1434. [Epub ahead of print]

  40. Sobel JD and Kaye D: Urinary Tract Infections. In Principles and Practices of Infectious Diseases, 8th Edition, (Eds. Bennett JE, Dolin R, and Blaser, MJ) Elsevier; 2015. p. 886–913.

  41. Falagas ME, Kastoris AC, Kapaskelis AM, et al. Fosfomycin for the treatment of multidrug resistant, including extended-spectrum beta-lactamase producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis. 2010;10:43–50.

    Article  CAS  PubMed  Google Scholar 

  42. Rudenko N, Dorofeyev A. Prevention of recurrent lower urinary tract infections by long-term administration of fosfomycin trometamol. Double blind, randomized, parallel group, placebo controlled study. Arzneimittelforschung. 2005;55:420–7.

    CAS  PubMed  Google Scholar 

  43. Amano M, Shimizu T. Emphysematous cystitis: a review of the literature. Intern Med. 2014;53:79–82.

    Article  PubMed  Google Scholar 

  44. Julka S. Genitourinary infection in diabetes. Indian J Endocrinol Metab. 2013;17(Suppl1):S83–7.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Bjurlin MA, Hurley SD, Kim DY, et al. Clinical outcomes of nonoperative management in emphysematous urinary tract infections. Urology. 2012;79:1281–5.

    Article  PubMed  Google Scholar 

  46. Gardiner RA, Gwynne RA, Roberts SA. Perinephric abscess. BJU Int. 2011;3:20–3.

    Article  Google Scholar 

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Donald Kaye declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Drexel University College of Medicine, Philadelphia, PA, USA

    Donald Kaye

  2. 1535 Sweet Briar Rd., Gladwyne, PA, 19035, USA

    Donald Kaye

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Correspondence to Donald Kaye.

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This article is part of the Topical Collection on Infectious Diseases in the Elderly

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Kaye, D. Complicated Urinary Tract Infection in the Geriatric Population. Curr Geri Rep 4, 79–86 (2015). https://doi.org/10.1007/s13670-014-0109-2

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  • DOI: https://doi.org/10.1007/s13670-014-0109-2

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