Urinary tract infection in geriatric and institutionalized patients.

The importance of urinary tract infection in elderly populations and some of the unique features in its evaluation and therapy are becoming better recognized. In elderly populations in the community there are concerns about increasing antimicrobial resistance in infecting organisms. In postmenopausal women, the importance of vaginal estrogen deficiency as a factor which promotes urinary tract infection is becoming increasingly recognized, leading to therapeutic strategies other than antimicrobials. For elderly residents of long term care facilities, urinary tract infection is very common, and most frequent in those with the greatest functional impairment. Whilst it is recognized that asymptomatic bacteriuria should not be treated, the diagnosis of urinary tract infection in this population often presents a dilemma. In particular, the urine culture is useful only in excluding urinary tract infection, not in making a diagnosis of symptomatic infection. There has been a tendency to manage all clinical deterioration in long term care facility residents who have positive urine cultures as urinary tract infection, contributing to excess antimicrobial use and heightening the problem of antimicrobial resistance. Recently published guidelines and commentaries attempt to address this problem.