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The burden of comorbidity is associated with symptomatic polymicrobial urinary tract infection among institutionalized elderly

Abstract

Background

Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host.

Aims

The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs.

Methods

We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the “Fondazione San Raffaele Cittadella della Carità”, Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI.

Results

P-UTIs were detected in 118/299 (39 %) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95 % CI 1.06–2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95 % CI 1.13–3.11; P = .015).

Discussion

The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases.

Conclusions

Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity.

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References

  1. 1.

    Hannan TJ, Totsika M, Mansfield KJ et al (2012) Host-pathogen checkpoints and population bottlenecks in persistent and intracellular uropathogenic Escherichia coli bladder infection. FEMS Microbiol Rev 36:616–648. doi:10.1111/j.1574-6976.2012.00339.x

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  2. 2.

    National Centers for Health Statistics (1997) Health, United States, 1996–1997, and injury chartbook. National Centers for Health Statistics, Hyattsville

    Google Scholar 

  3. 3.

    Croxall G, Weston V, Joseph S et al (2011) Increased human pathogenic potential of Escherichia coli from polymicrobial urinary tract infections in comparison to isolates from monomicrobial culture samples. J Med Microbiol 60:102–109. doi:10.1099/jmm.0.020602-0

    Article  PubMed  Google Scholar 

  4. 4.

    D’Agata E, Loeb MB, Mitchell SL (2013) Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. J Am Geriatr Soc 61:62–66. doi:10.1099/jmm.0.020602-0

    PubMed Central  Article  PubMed  Google Scholar 

  5. 5.

    Frank DN, Wilson SS, St Amand AL, Pace NR (2009) Culture-independent microbiological analysis of foley urinary catheter biofilms. PLoS One 4:e7811. doi:10.1371/journal.pone.0007811

    PubMed Central  Article  PubMed  Google Scholar 

  6. 6.

    Domann E, Hong G, Imirzalioglu C et al (2003) Culture-independent identification of pathogenic bacteria and polymicrobial infections in the genitourinary tract of renal transplant recipients. J Clin Microbiol 41:5500–5510

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  7. 7.

    Genao L, Buhr GT (2012) Urinary tract infections in older adults residing in long-term care facilities. Ann Longterm Care 20:33–38

    PubMed Central  PubMed  Google Scholar 

  8. 8.

    Brzuszkiewicz E, Brüggemann H, Liesegang H et al (2006) How to become a uropathogen: comparative genomic analysis of extraintestinal pathogenic Escherichia coli strains. Proc Natl Acad Sci USA 103:12879–12884

    PubMed Central  Article  PubMed  Google Scholar 

  9. 9.

    Warren JW, Abrutyn E, Hebel JR et al (1999) Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 29:745–758

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Hooton TM, Bradley SF, Cardenas DD, Infectious Diseases Society of America et al (2010) 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 50:625–663

    Article  PubMed  Google Scholar 

  11. 11.

    Stone ND, Ashraf MS, Calder J, Society for Healthcare Epidemiology Long-Term Care Special Interest Group et al (2012) Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 33:965–977. doi:10.1086/667743

    PubMed Central  Article  PubMed  Google Scholar 

  12. 12.

    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  15. 15.

    WHO Collaborating Centre for Drug Statistics Methodology (1982) “ATC/DDD methodology: history”. http://www.whocc.no/atc_ddd.../who_collaborating_centre/. Accessed 26 June 2012

  16. 16.

    Marschall J, Piccirillo ML, Foxman B, CDC Prevention Epicenters Program et al (2013) Patient characteristics but not virulence factors discriminate between asymptomatic and symptomatic E. coli bacteriuria in the hospital. BMC Infect Dis 13:213. doi:10.1186/1471-2334-13-213

    PubMed Central  Article  PubMed  Google Scholar 

  17. 17.

    Briongos-Figuero LS, Gómez-Traveso T, Bachiller-Luque P et al (2012) Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract 66:891–896. doi:10.1111/j.1742-1241.2012.02991.x

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Smith PW, Bennett G, Bradley S, Society for Healthcare Epidemiology of America (SHEA), Association for Professionals in Infection Control and Epidemiology (APIC) et al (2008) SHEA/APIC guideline: infection prevention and control in the long-term care facility. Am J Infect Control 36:504–535. doi:10.1016/j.ajic.2008.06.001

    PubMed Central  Article  PubMed  Google Scholar 

  19. 19.

    Trautner BW, Hull RA, Darouiche RO (2005) Prevention of catheter-associated urinary tract infection. Curr Opin Infect Dis 18:37–41

    PubMed Central  Article  PubMed  Google Scholar 

  20. 20.

    Stickler DJ (2008) Bacterial biofilms in patients with indwelling urinary catheters. Nat Clin Pract Urol. 5:598–608. doi:10.1038/ncpuro1231

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Chakupurakal R, Ahmed M, Sobithadevi DN et al (2010) Urinary tract pathogens and resistance pattern. J Clin Pathol 63:652–654. doi:10.1136/jcp.2009.074617

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Rodríguez-Avial C, Rodríguez-Avial I, Hernández E et al (2013) Increasing prevalence of fosfomycin resistance in extended-spectrum-beta-lactamase-producing Escherichia coli urinary isolates (2005-2009-2011). Rev Esp Quimioter 26:43–46

    PubMed  Google Scholar 

  23. 23.

    Moro ML, Ricchizzi E, Morsillo F et al (2013) Infections and antimicrobial resistance in long term care facilities: a national prevalence study. Ann Ig 25:109–118. doi:10.7416/ai.2013.1912

    CAS  PubMed  Google Scholar 

  24. 24.

    Ljuca S, Zvizdic S, Hamzic S et al (2010) Antimicrobial susceptibility of bacteria isolated from inpatients and outpatients urine samples. Med Arh 64:161–164

    PubMed  Google Scholar 

  25. 25.

    Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 113(Suppl 1A):5S–13S

    Article  PubMed  Google Scholar 

  26. 26.

    Adamus-Bialek W, Zajac E, Parniewski P et al (2013) Comparison of antibiotic resistance patterns in collections of Escherichia coli and Proteus mirabilis uropathogenic strains. Mol Biol Rep 40:3429–3435. doi:10.1007/s11033-012-2420-3

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  27. 27.

    Khasriya R, Sathiananthamoorthy S, Ismail S et al (2013) Spectrum of bacterial colonization associated with urothelial cells from patients with chronic lower urinary tract symptoms. J Clin Microbiol 51:2054–2062. doi:10.1128/JCM.03314-12

    PubMed Central  Article  PubMed  Google Scholar 

  28. 28.

    Jacobsen SM, Stickler DJ, Mobley HL et al (2008) Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis. Clin Microbiol Rev 21:26–59. doi:10.1128/CMR.00019-07

    PubMed Central  CAS  Article  PubMed  Google Scholar 

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standard

All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

All participants signed an informed consent form prior to be included in the study.

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Correspondence to Alice Laudisio.

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Laudisio, A., Marinosci, F., Fontana, D. et al. The burden of comorbidity is associated with symptomatic polymicrobial urinary tract infection among institutionalized elderly. Aging Clin Exp Res 27, 805–812 (2015). https://doi.org/10.1007/s40520-015-0364-x

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Keywords

  • Elderly
  • Nursing home
  • Comorbidity
  • Urinary infection
  • Epidemiology