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DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS Skip to content Yıl 2024, Cilt: 25 Sayı: 3, 370 – 376, 18.07.2024
Cihan Semet
https://doi.org/10.18229/kocatepetip.1380928
Öz OBJECTIVE: Urinary tract infections are common in older adults and associated with significant morbidity and mortality. This study aimed to characterize the clinical features, bacterial etiologies, antimicrobial resistance patterns, and risk factors for mortality in elderly patients hospitalized with urinary tract infection. MATERIAL AND METHODS: Data were retrospectively analyzed from 118 patients aged ≥65 years hospitalized with a diagnosis of urinary tract infection between January 2018 and December 2022. Urinary tract infections were defined according to Centers for Disease Control and Prevention criteria. Isolated microorganisms in urine cultures and antimicrobial resistance rates were determined. Risk factors associated with mortality were evaluated by logistic regression analysis. RESULTS: 50.8% of patients were female; the mean age was 72.5±7.0 years. The most common symptoms were dysuria (65.3%), anorexia (65.3%), and flank pain (57.6%). Forty-nine patients (41.5%) had nosocomial urinary tract infections. All cause in hospital mortality was observed in 48 patients (40.6%), and 22 patients (18.6%) had in-hospital mortality directly related to urinary tract infection. Urosepsis (OR: 13.518, 95% CI: 1.711-106.793, p=0.014), kidney stones (OR: 7.529, 95% CI: 1.596-35.525, p=0.011) and urinary tract infections caused by multidrug-resistant organisms (OR: 18. 612, 95% CI: 1.564-4.283, p<0.001) were independent risk factors for mortality, and appropriate treatment (OR: 0.090, 95% CI: -3.736–1.085, p<0.001) was an independent protective factor for mortality. CONCLUSIONS: Urinary tract infections in elderly adults present with a wide range of symptoms and are predominantly caused by drug-resistant Escherichia coli. Urosepsis and kidney stones are critical determinants of mortality, emphasizing the need for rapid and appropriate management strategies. Understanding the etiology, clinical features, and mortality risk factors of urinary tract infections in elderly adults is crucial for optimizing infection management in this vulnerable population.
Anahtar Kelimeler Urinary tract infection, Elderly, Etiology, Resistance, Mortality.
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Risk Factors for Urinary Tract Infections in Postmenopausal Women. Archives of Internal Medicine. 2004;164:989. 16. Jacobsen S, Stickler D, Mobley H, Shirtliff M. Complicated catheter-associated urinary tract infections due to escherichia coli and proteus mirabilis. Clinical Microbiology Reviews. 2008;21(1):26-59. 17. Tuddenham S, Gearhart S, Wright E, Handa V. Frailty and postoperative urinary tract infection. BMC Geriatrics. 2022;22(1):828. 18. Kushner P. Benefits/risks of sodium–glucose co-transporter 2 inhibitor canagliflozin in women for the treatment of type 2 diabetes. Women S Health. 2016;12(3):379-388. 19. Wang W, Tan T, Ho C, et al. Association between osteoarthritis and urinary tract infection in older adults: a nationwide population-based cohort study. Medicine. 2022;101(33):30007. 20. Luo Z, Xiang Y, Shen C, Ren Y, Wang S, Wu G. Characteristics and drug resistance of pathogens in urinary tract infection patients complicated with urinary calculi. IJPS. 2020;82(5). 21. Fanshawe TR, Judge RK, Mort S, Butler CC, Hayward GN. Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study. Journal of Antimicrobial Chemotherapy. 2023;78(8):2080-88. 22. Abraham SN, Miao Y. The nature of immune responses to urinary tract infections. Nature Reviews Immunology. 2015;15:655–63. 23. Tanyel E, Fışgın N, Tülek N, Leblebicioğlu H. Yaşlı hastalardaki üriner sistem infeksiyonlarının değerlendirilmesi. İnfeksiyon Dergisi. 2006;20(2):87-91. 24. Smithson A, Ramos J, Niño E, et al. Characteristics of febrile urinary tract infections in older male adults. BMC Geriatrics. 2019;19:334. 25. Eliakim-Raz N, Babitch T, Shaw E, et al. Risk Factors for Treatment Failure and Mortality among Hospitalised Patients with Complicated Urinary Tract Infection: A Multicentre Retrospective Cohort Study, RESCUING Study Group. Clinical Infectious Diseases. 2018;68:29-36. 26. Esme M, Topeli A, Yavuz BB, Akova M. Infections in the Elderly Critically-Ill Patients. Frontiers in Medicine. 2019;6(6):118. 27. Dreger NM, Degener S, Ahmad-Nejad P, Wöbker G, Roth S. Urosepsis Etiology, Diagnosis, and Treatment. Deutsches Ärzteblatt International. 2015;112(49):837-47. 28. Wagenlehner FME, Pilatz A, Weidner W, Naber KG. Urosepsis: Overview of the Diagnostic and Treatment Challenges. Microbiology Spectrum. 2015;3(5). 29. Bhanot R, Pietropaolo A, Tokas T, et al. Predictors and Strategies to Avoid Mortality Following Ureteroscopy for Stone Disease: A Systematic Review from European Association of Urologists Sections of Urolithiasis (EULIS) and Uro-technology (ESUT). European Urology Focus. 2022;8:598–607. 30. Whitehurst LA, Jones P, Somani BK. Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review. World Journal of Urology. 2018;37:759-76. 31. Ziółkowski G, Pawłowska I, Stasiowski M, Jachowicz E, Wójkowska-Mach J, Bielecki T. Multidrug-Resistant Micro-Organisms Associated with Urinary Tract Infections in Orthopedic Patients: A Retrospective Laboratory-Based Study. Antibiotics. 2020;10(1):7. 32. Robinson JL, Le Saux N. Management of urinary tract infections in children in an era of increasing antimicrobial resistance. Expert Review of Anti-infective Therapy. 2016;14:809 – 16.
YAŞLI YETİŞKİNLERDE İDRAR YOLU ENFEKSİYONLARININ TANIMLAYICI ÖZELLİKLERİ, ETİYOLOJİK AJANLAR VE MORTALİTE RİSK FAKTÖRLERİ Yıl 2024, Cilt: 25 Sayı: 3, 370 – 376, 18.07.2024
Cihan Semet
https://doi.org/10.18229/kocatepetip.1380928
Öz AMAÇ: İdrar yolu enfeksiyonları yaşlı erişkinlerde sıklıkla görülmekte ve önemli morbidite ve mortalite ile ilişkilendirilmektedir. Bu çalışmanın amacı, idrar yolu enfeksiyonu ile hastaneye yatırılan yaşlı hastaların klinik özelliklerini, bakteriyel etiyolojilerini, antimikrobiyal direnç paternlerini ve mortalite için risk faktörlerini karakterize etmektir. GEREÇ VE YÖNTEM: Ocak 2018 ile Aralık 2022 tarihleri arasında idrar yolu enfeksiyonu tanısıyla hastaneye yatırılan ≥65 yaş 118 hastanın verileri retrospektif olarak analiz edilmiştir. İdrar yolu enfeksiyonları Hastalık Kontrol ve Korunma Merkezleri (Centers for Disease Control and Prevention) kriterlerine göre tanımlanmıştır. İdrar kültürlerinde izole edilen mikroorganizmalar ve antimikrobiyal direnç oranları belirlenmiştir. Mortalite ile ilişkili risk faktörleri lojistik regresyon analizi ile değerlendirilmiştir. BULGULAR: Hastaların %50,8’i kadındı; ortalama yaş 72,5±7,0 yıldı. En sık görülen semptomlar dizüri (%65,3), anoreksi (%65,3) ve yan ağrısı (%57,6) idi. En sık izole edilen patojen Escherichia coli (%29,4) olmuştur. Olguların 49’u (%41,5) nozokomiyal idrar yolu enfeksiyonu idi. Tüm nedenlere bağlı hastane içi mortalite 48 hastada (%40,6) gözlenirken, 22 hastada (%18,6) doğrudan idrar yolu enfeksiyonu ile ilişkili hastane içi mortalite görülmüştür. Ürosepsis (odds ratio (OR):13.518, %95 CI: 1.711-106.793, p=0.014), böbrek taşı (OR:7.529, %95 CI: 1.596-35.525, p=0.011) ve çok ilaca dirençli organizmaların neden olduğu idrar yolu enfeksiyonları (OR: 18.612, %95 CI: 1.564-4.283, p<0.001) mortalite için bağımsız risk faktörleri, uygun tedavinin (OR: 0.090, %95 CI: -3.736–1.085, p<0.001) mortalite için bağımsız bir koruyucu faktör olduğu bulunmuştur. SONUÇ: Yaşlı yetişkinlerde idrar yolu enfeksiyonları çok çeşitli semptomlarla ortaya çıkar ve ağırlıklı olarak ilaca dirençli Escherichia coli’den kaynaklanır. Ürosepsis ve böbrek taşları mortalitenin kritik belirleyicileridir ve hızlı ve uygun yönetim stratejilerine duyulan ihtiyacı vurgular. Yaşlı yetişkinlerde idrar yolu enfeksiyonlarının etiyolojisi, klinik özellikleri ve mortalite risk faktörlerinin bilinmesi, bu hassas popülasyonda enfeksiyon yönetimini optimize etmek için çok önemlidir.
Anahtar Kelimeler İdrar yolu enfeksiyonu, Yaşlı, Etiyoloji, Direnç, Mortalite.
Kaynakça 1. Shesteryakova IV, Galkina OV, Sergeenko YS. Social Protection of Persons of the Elder Generation. Complex Social Systems in Dynamic Environments. 2023:619–25. 2. Heudorf U, Boehlcke K, Schade M. Healthcare-associated infections in long-term care facilities (HALT) in Frankfurt am Main, Germany, January to March 2011. Eurosurveillance. 2012;17. 3. Nicolle LE. Urinary Tract Infections in the Older Adult. Clinics in Geriatric Medicine. 2016;32:523–38. 4. Nauclér P, Huttner A, van Werkhoven CH, et al. Impact of time to antibiotic therapy on clinical outcome in patients with bacterial infections in the emergency department: implications for antimicrobial stewardship. Clinical Microbiology and Infection. 2021;27:175–81. 5. Jump RLP, Crnich CJ, Mody L, Bradley SF, Nicolle LE, Yoshikawa TT. Infectious Diseases in Older Adults of Long-Term Care Facilities: Update on Approach to Diagnosis and Management. Journal of the American Geriatrics Society. 2018;66:789–803. 6. 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Paul M, Shani V, Muchtar E, Kariv G, Robenshtok E, Leibovici L. Systematic Review and Meta-Analysis of the Efficacy of Appropriate Empiric Antibiotic Therapy for Sepsis. Antimicrobial Agents and Chemotherapy 2010;54:4851–63. 12. Zhang, David, et al. Time to Appropriate Antibiotic Therapy Is an Independent Determinant of Postinfection ICU and Hospital Lengths of Stay in Patients With Sepsis Critical Care Medicine. 2015;43:2133–40. 13. Marques LPJ, Flores JT, Barros Junior O de O, Rodrigues GB, et al. Epidemiological and clinical aspects of urinary tract infection in community-dwelling elderly women. The Brazilian Journal of Infectious Diseases. 2012;16:436–41. 14. Sotto A, De Boever CM, Fabbro-Peray P, Gouby A, Sirot D, et al. Risk Factors for Antibiotic-Resistant Escherichia coli Isolated from Hospitalized Patients with Urinary Tract Infections: a Prospective Study. Journal of Clinical Microbiology. 2001;39:438–44. 15. Hu KK, Boyko EJ, Scholes D, et al. Risk Factors for Urinary Tract Infections in Postmenopausal Women. Archives of Internal Medicine. 2004;164:989. 16. Jacobsen S, Stickler D, Mobley H, Shirtliff M. Complicated catheter-associated urinary tract infections due to escherichia coli and proteus mirabilis. Clinical Microbiology Reviews. 2008;21(1):26-59. 17. Tuddenham S, Gearhart S, Wright E, Handa V. Frailty and postoperative urinary tract infection. BMC Geriatrics. 2022;22(1):828. 18. Kushner P. Benefits/risks of sodium–glucose co-transporter 2 inhibitor canagliflozin in women for the treatment of type 2 diabetes. Women S Health. 2016;12(3):379-388. 19. Wang W, Tan T, Ho C, et al. Association between osteoarthritis and urinary tract infection in older adults: a nationwide population-based cohort study. Medicine. 2022;101(33):30007. 20. Luo Z, Xiang Y, Shen C, Ren Y, Wang S, Wu G. Characteristics and drug resistance of pathogens in urinary tract infection patients complicated with urinary calculi. IJPS. 2020;82(5). 21. Fanshawe TR, Judge RK, Mort S, Butler CC, Hayward GN. Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study. Journal of Antimicrobial Chemotherapy. 2023;78(8):2080-88. 22. Abraham SN, Miao Y. The nature of immune responses to urinary tract infections. Nature Reviews Immunology. 2015;15:655–63. 23. Tanyel E, Fışgın N, Tülek N, Leblebicioğlu H. Yaşlı hastalardaki üriner sistem infeksiyonlarının değerlendirilmesi. İnfeksiyon Dergisi. 2006;20(2):87-91. 24. Smithson A, Ramos J, Niño E, et al. Characteristics of febrile urinary tract infections in older male adults. BMC Geriatrics. 2019;19:334. 25. Eliakim-Raz N, Babitch T, Shaw E, et al. Risk Factors for Treatment Failure and Mortality among Hospitalised Patients with Complicated Urinary Tract Infection: A Multicentre Retrospective Cohort Study, RESCUING Study Group. Clinical Infectious Diseases. 2018;68:29-36. 26. Esme M, Topeli A, Yavuz BB, Akova M. Infections in the Elderly Critically-Ill Patients. Frontiers in Medicine. 2019;6(6):118. 27. Dreger NM, Degener S, Ahmad-Nejad P, Wöbker G, Roth S. Urosepsis Etiology, Diagnosis, and Treatment. Deutsches Ärzteblatt International. 2015;112(49):837-47. 28. Wagenlehner FME, Pilatz A, Weidner W, Naber KG. Urosepsis: Overview of the Diagnostic and Treatment Challenges. Microbiology Spectrum. 2015;3(5). 29. Bhanot R, Pietropaolo A, Tokas T, et al. Predictors and Strategies to Avoid Mortality Following Ureteroscopy for Stone Disease: A Systematic Review from European Association of Urologists Sections of Urolithiasis (EULIS) and Uro-technology (ESUT). European Urology Focus. 2022;8:598–607. 30. Whitehurst LA, Jones P, Somani BK. Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review. World Journal of Urology. 2018;37:759-76. 31. Ziółkowski G, Pawłowska I, Stasiowski M, Jachowicz E, Wójkowska-Mach J, Bielecki T. Multidrug-Resistant Micro-Organisms Associated with Urinary Tract Infections in Orthopedic Patients: A Retrospective Laboratory-Based Study. Antibiotics. 2020;10(1):7. 32. Robinson JL, Le Saux N. Management of urinary tract infections in children in an era of increasing antimicrobial resistance. Expert Review of Anti-infective Therapy. 2016;14:809 – 16. Toplam 32 adet kaynakça vardır.
Ayrıntılar Birincil Dil İngilizce Konular Bulaşıcı Hastalıklar Bölüm Makaleler-Araştırma Yazıları Yazarlar Cihan Semet TC. Sağık Bakanlığı, İnegöl Devlet Hastanesi 0000-0003-2210-820X Türkiye
Yayımlanma Tarihi 18 Temmuz 2024 Gönderilme Tarihi 26 Ekim 2023 Kabul Tarihi 5 Mart 2024 Yayımlandığı Sayı Yıl 2024 Cilt: 25 Sayı: 3
Kaynak Göster APA Semet, C. (2024). DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS. Kocatepe Tıp Dergisi, 25(3), 370-376. https://doi.org/10.18229/kocatepetip.1380928 AMA Semet C. DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS. KTD. Temmuz 2024;25(3):370-376. doi:10.18229/kocatepetip.1380928 Chicago Semet, Cihan. “DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS”. Kocatepe Tıp Dergisi 25, sy. 3 (Temmuz 2024): 370-76. https://doi.org/10.18229/kocatepetip.1380928. EndNote Semet C (01 Temmuz 2024) DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS. Kocatepe Tıp Dergisi 25 3 370–376. IEEE C. Semet, “DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS”, KTD , c. 25, sy. 3, ss. 370–376, 2024, doi: 10.18229/kocatepetip.1380928. ISNAD Semet, Cihan. “DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS”. Kocatepe Tıp Dergisi 25/3 (Temmuz 2024), 370-376. https://doi.org/10.18229/kocatepetip.1380928. JAMA Semet C. DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS. KTD . 2024;25:370–376. MLA Semet, Cihan. “DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS”. Kocatepe Tıp Dergisi, c. 25, sy. 3, 2024, ss. 370-6, doi:10.18229/kocatepetip.1380928. Vancouver Semet C. DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS. KTD. 2024;25(3):370-6.
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