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Harnwegsinfekte im Alter

Urinary tract infections in the elderly

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Zusammenfassung

Harnwegsinfekte sind eine der am häufigsten vorkommenden bakteriellen Infektionen. Bei gebrechlichen älteren Menschen sind sie verantwortlich für eine erhebliche Morbidität sowie rezidivierende Infektionen mit nachfolgenden Resistenzen gegen Antibiotika. Obwohl eine Therapie häufig entweder nicht notwendig erscheint oder durch eine kurze Antibiotikatherapie behandelt wird, kommt es immer wieder zu teils hochakuten Krankheitsverläufen und Reinfektionen. Die biologische Komplexität der Infektionsmechanismen und die dramatisch hohen Zahlen von antibiotikaresistenten Pathogenen, machen eine intelligente Therapiestrategie notwendig und stellen damit nicht nur eine klinische Herausforderung dar, sondern ermöglichen auch die rasche Heilung. Der erste entscheidende Schritt ist die genaue Klassifizierung des Harnweginfekts von der symptomfreien Bakteriurie bis zur komplizierten Pyelonephritis. Hier wird bereits über die Aggressivität der Behandlung sowie den diagnostischen Aufwand entschieden. Für die Entwicklung einer empirischen antimikrobiellen Therapie ist die Kenntnis der häufigsten Erreger sowie der lokalen Resistenzmuster wichtig. Bei gezieltem Vorgehen können die meisten Harnwegsinfekte auch beim geriatrischen Patienten ohne erhöhten diagnostischen Aufwand therapiert werden.

Abstract

Acute infection of the urinary tract is one of the most commonly encountered bacterial infections in the frail elderly population and is responsible for substantial morbidity and recurrent infections with antibiotic resistance. Although generally considered to be self-limiting without treatment or easily treated with a short antibiotic regime, urinary tract infections (UTIs) often have a dramatic history, associated with incomplete resolution and frequent recurrence. The biological complexity of the infections combined with a dramatic rise in antibiotic-resistant pathogens highlight the need for an anticipating strategy for therapy necessary for a rapid recovery. The first crucial step is the classification in asymptomatic bacteriuria or complicated pyelonephritis, on which the decision for the intensity of treatment and diagnostic effort is based. For the selection of empiric antibiotic therapy, knowledge about the predominant uropathogens as well as local resistance patterns is important. In this manner, most urinary tract infections in the elderly can be treated without greater expense.

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Authors and Affiliations

  1. Abteilung Geriatrie und Frührehabilitation, HELIOS Hanseklinikum Stralsund, Große Parower Straße 47–54, 18437, Stralsund, Deutschland

    Klaus Friedrich Becher MHBA, M.D.

  2. Abteilung für Klinische Hygiene und Infektiologie, HELIOS Hanseklinikum Stralsund, Große Parower Straße 47–54, 18437, Stralsund, Deutschland

    Ingo Klempien M.D.

  3. Urologische Abteilung, Lehrstuhl für Geriatrie, Evangelisches Krankenhaus im Diakoniewerk Ruhr, Universität Witten, Pferdebachstr. 27–43, 58455, Witten, Deutschland

    Andreas Wiedemann M.D., PHD

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Correspondence to Klaus Friedrich Becher MHBA, M.D..

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K.F. Becher, I. Klempien und A. Wiedemann geben an, dass kein Interessenkonflikt besteht.

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Becher, K., Klempien, I. & Wiedemann, A. Harnwegsinfekte im Alter. Z Gerontol Geriat 48, 588–594 (2015). https://doi.org/10.1007/s00391-015-0947-3

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  • DOI: https://doi.org/10.1007/s00391-015-0947-3

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