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270 individuals with an average age of 83.7 years who were activities, and urinary incontinence. Gender and place of re-
hospitalized due to UTI (including 14% from nursing homes) sidence were not risk factors for UTI .
14
showed that hospital mortality was 8.9%. Risk factors for
mortality included inadequate antimicrobial therapy, APA- In individuals residing in long-term care facilities for the
CHE II score on admission ≥ 15, dementia, and solid neo- elderly, ASB is associated with urinary dysfunction due to
plasms . An Israeli study involving 191 individuals (of whom neurological disorders (cerebrovascular diseases, Parkin-
6
35% were from nursing homes) aged 75 to 105 years, hos- son's disease, dementia), which are also the reasons for
15
pitalized in a geriatric hospital, showed an in-hospital mor- placement in specialized facilities . Residual urine volume
tality of 33%. Risk factors included hospitalization (lasting does not correlate with the occurrence of symptomatic or
longer than 20 days), dementia, and comorbidities, rather asymptomatic infection. Men who use external urinary cat-
than gender and age . The mortality of patients with UTI de- heters in the form of condoms have a higher frequency of
7
pends on multiple factors. bacteriuria and symptomatic infections compared to incon-
tinent men who do not use them .
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Pathogenesis
Infection causing agents
In non-hospitalized older adults, risk factors are similar
for ASB and UTI and include menopause, prostate hyper- In the case of symptomatic infections, the most com-
trophy, diabetes mellitus, functional and cognitive impair- mon causative agents isolated are E. coli, but also Entero-
ment, and incontinence. In postmenopausal women, recu- bacteriaceae, Enterococcus spp, and Pseudomonas aerugi-
rrent infections are associated with frequent infections in nosa. Coagulase-negative staphylococci can be isolated in
youth and non-secretion of blood group antigens . Women asymptomatic infections in men. Candida can be detected
8
with diabetes, aged 55-75 years, have twice the frequen- in individuals with additional risk factors such as diabetes,
cy of UTIs compared to women without diabetes . Due to urological aids, and the use of broad-spectrum antibiotics.
9
estrogen deficiency, colonization with Lactobacilli spp, whi- In the elderly, isolates are more likely to be multidrug-resi-
ch maintains the acidic pH of the vagina, decreases in the stant compared to younger individuals, which is associated
postmenopausal period. A higher pH allows colonization by with previous (mis)use of antibiotics and urological proce-
uropathogens (E. coli and Enterococcus spp), increasing the dures in patients with complicated infections. A Spanish
incidence of UTIs in postmenopausal women . It is believed study confirmed that in ambulatory patients with urinary
10
that estrogen replacement therapy can restore vaginal flora tract infections, older age was significantly associated with
and pH, although the association between infections and the isolation of fluoroquinolone-resistant E. coli, and an in-
estrogen is not fully understood. dependent risk factor for this resistance was the use of an-
tibiotics during the previous month . Similarly, data from
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Prostatic hypertrophy plays a significant role in the pat- an American study showed tigecycline-resistant, carbape-
hogenesis of UTIs in older men. It causes obstruction and nem-resistant Klebsiella pneumoniae, and the risk factor
turbulent urine flow, facilitating bacterial penetration into was hospitalization from nursing homes . Additionally, E.
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the bladder wall. Bacteria may remain in the prostate per- coli is the most common pathogen in nursing homes, but
manently due to poor penetration of antibiotics into the the prevalence of other enterobacteria is higher compa-
gland. Incontinence predisposes to bacteriuria, but it can red to ambulatory patients. In institutionalized individuals,
also be a cause of infections in older men and women. Resi- polymicrobial infections are more common (10-25%), even
dual urine volume is a common finding in female individu- without the presence of an indwelling catheter, and antimi-
als between the ages of 62 and 90 . In men with a median crobial resistance is also more prevalent, making treatment
11
age of 62 years, the average residual urine volume was 257 more challenging.
mL in cases of positive bacteriuria and 133 mL without ba-
cteriuria . However, a prospective study did not confirm a
12
correlation between UTI and residual urine volume in wo- Diagnosis
men aged 55-75 years, indicating a complex relationship
between these two clinical conditions . Clinical diagnosis is based on a spectrum of symptoms,
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ranging from irritation of the lower urinary tract to septic
A special focus is warranted on very elderly individuals, shock. In ambulatory patients, common symptoms include
aged over 80 years. A Swedish study confirmed that risk fa- frequent urination, dysuria, nocturia, suprapubic pain, and
ctors for bacteriuria in very elderly women include immobi- sometimes hematuria. Symptoms of pyelonephritis also inc-
lity, incontinence, and estrogen therapy, while in men, risk lude pain in the costovertebral region, fever, and elevated
factors include prostate issues, history of stroke, and de- temperature, with or without dysuria. However, clinical dia-
pendency on others . Data from the Netherlands for older gnosis is more challenging in individuals residing in nursing
3
individuals (aged 80 to 90 years) showed that risk factors homes due to impaired communication and the presence of
for UTI include cognitive impairment, dependence on daily symptoms of chronic diseases. Clinical deterioration in pa-
tients without localized genitourinary symptoms is unlikely

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):48-53. 49