Page 52 - GALENIKA MEDICAL JOURNAL

to be due to UTI in individuals with bacteriuria . However, colonies may be isolated if frequent urination disrupts the
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atypical symptoms and changes in the patient's clinical incubation time of bacteria in the bladder due to frequent
status, such as falls, reduced functionality, and changes in emptying. Therefore, for men, the diagnosis of UTI is pre-
mental status, are often attributed to UTIs in the elderly. sent if pathogens are isolated in a number of 10 CFU/mL
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Changes in the odor, color, and cloudiness of urine correla- or more in a properly collected urine sample (except in the
te with bacteriuria but are more commonly associated with case of a permanent urinary catheter, when the criterion is
worsening incontinence or dehydration rather than symp- 10 CFU/mL) . If pyelonephritis is suspected, finding a sin-
5
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tomatic infection, so they are not sufficient for diagnosing gle microorganism in a number of 10 CFU/mL or above is
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UTI 18-20 . Recognizing symptoms is very important because the recommended diagnostic criterion. Finding microorga-
they are the primary criteria for initiating therapy when UTI nisms in a number of 10 CFU/mL or above is indicative of
2
is suspected: acute dysuria or high temperature, acute con- infection if the sample is obtained by a single-use catheteri-
fusion or fever with worsening of one of the genitourinary zation of the bladder .
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symptoms (urgent urination, frequent urination, suprapu-
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bic pain, hematuria, pain in the costovertebral region, uri- Pyuria is a nonspecific laboratory finding in the elderly .
nary incontinence) 21, 22 . This significantly reduces antibiotic It is often positive even without bacteriuria, and in individu-
use compared to the standard approach. In cases where the als with bacteriuria, it does not differentiate symptomatic
diagnosis is unreliable, it is advisable to monitor the patient UTI from ASB. On the other hand, the absence of pyuria has
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and, if local symptoms in the genitourinary tract area do not a high negative predictive value for excluding UTI . When
appear, the patient should be treated more as a condition of UTI is suspected in individuals in nursing homes, it is advi-
sepsis of unknown origin rather than as UTI . sable to first examine the presence of pyuria. If the finding
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is negative, a urine culture should not be performed . In
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Laboratory diagnosis is necessary for definitive dia- women older than 80 years, elevated levels of leukocyte
gnosis and treatment of UTIs in the elderly, given the high esterase, interleukin IL-8, and IL-6 may indicate a differen-
percentage of microorganism resistance . An exception is ce between ASB and acute cystitis. However, determining
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healthy women who have repeated acute cystitis in outpa- these biomarkers does not have significant clinical signifi-
tient settings, where short-term antibiotic therapy is usually cance . In cases of suspected urosepsis, finding the same
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effective. However, even in these cases, urine culture should bacteria in both blood and urine indicates the source of the
be performed if the desired effect on empirical therapy is infection.
not achieved, if symptoms are atypical, or if there is a rapid
return of symptoms after treatment, all of which indicate a
resistant pathogen. Antimicrobial treatment

One of the primary obstacles in UTI diagnosis is the In older adults, treatment for asymptomatic bacteri-
necessity of proper urine sampling for analysis to prevent uria (ASB) is not recommended as it does not reduce the
sample contamination. In women who are unable to follow occurrence and frequency of subsequent UTIs, nor does it
instructions, a single-use catheterization is performed, whi- alleviate symptoms, and it may lead to the emergence of
le in men, a clean condom catheter is used. The diagnostic unwanted treatment effects . Therefore, screening older
2
criterion involves finding more than 10 CFU/mL of a single adults for ASB is not indicated.
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microorganism in the urine sample. When a smaller num-
ber of colonies is isolated or multiple microorganisms are When selecting antimicrobial therapy, one should consi-
present, the urine culture result is interpreted by clinical der the drug's effectiveness, patient tolerance, clinical pre-
symptoms. A lower colony count is encountered in about sentation of the disease, renal function, need for parenteral
10% of healthy postmenopausal women with acute un- administration routes, and treatment cost. If the clinical pi-
complicated UTI . Additionally, in UTIs, a lower number of cture allows, waiting for the results of the urine culture is
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Table 1. Selection and dosing of antimicrobial drugs in the treatment of urinary tract infections in elderly individuals with normal kidney
function
Peroral therapy Parenteral therapy
Trimethoprim/Sulfametoxazol 2 x 160/800 mg Nitrofurantoin 2 x 100 mg Amoxicillin 4 x 500 mg ± Gentamicin or Tobramycin 5-7 mg/kg/24 h
Ciprofloxacin 2 x 250-500 mg Ceftriaxone 1-2 g/24 h
First line Norfloxacin 2 x 400 mg Cefotaxime 3 x 1 g
Levofloxacin 1 x 250-500 mg Ciprofloxacin 2 x 400 mg
Levofloxacin 500-750 mg/24 h
Amoxicillin 3 x 500 mg Amikacin 2 x 7,5 mg/kg or 1 x 15 mg/kg
Amoxicillin/clavulanic acid 2 x 875 mg or 3 x 500 mg Cefazolin 3 x 1 g
Cephalexin 4 x 500 mg Ceftazidime 3 x 1 g
Cefuroxime 2 x 500 mg Ceftazidime/Avibactam 3 x 2,5 g
Second line Cefixime 1 x 400 mg Doripenem 4 x 500 mgg
Doxycycline 2 x 100 mg Ertapenem 1 x 1 g
Fosfomycin 3 g Meropenem 4 x 500 mg or 3 x 1 g
Trimethoprim 2 x 100 mg Piperacillin/Tazobactam 3 x 3,375 g
Vancomycin (for Gram+) 2 x 1 g

50 DOI: 10.5937/Galmed2409055D