E Álvarez Artero1, A Campo Nuñez1, M Garcia Bravo2, O Cores Calvo3, M Belhassen Garcia4, J Pardo Lledias5. 1. Servicio de Medicina Interna, Hospital Río Carrión, Complejo Asistencial de Palencia (CAUPA), Palencia, España. 2. Servicio de Microbiología, Hospital Río Carrión, CAUPA, Palencia, España. 3. Servicio de Microbiología, CAUSA, Salamanca, España. 4. Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación en Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Salamanca, España. Electronic address: mbelhassen@hotmail.com. 5. Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla (HUMV), Santander, Cantabria, España. Electronic address: Javipard2@hotmail.es.
Abstract
INTRODUCTION: Urinary tract infections (UTIs) are one of the most frequent infections. In the elderly, they have multiple comorbidities. The objective of this work is to describe the clinical and microbiological epidemiology of elderly persons admitted for UTIs and to evaluate the suitability of empirical treatments and their implications regarding mortality. MATERIAL AND METHODS: An observational study was conducted during 2013-2015 in 4public hospitals, with patients older than 65 years who were admitted to the Internal Medicine service with a microbiological diagnosis of UTI. Cases of asymptomatic bacteriuria were excluded. In-hospital mortality was analyzed. Univariate analysis and multivariate analysis was carried out. RESULTS: A total of 349 episodes were selected, with a mean age of 82 ± 11 years, 51% female. Mortality was 10.3% and was associated with age, dementia and sepsis and septic shock (P<.05). The most frequent organisms were Escherichia coli(E. coli) (53.6%), Klebsiella spp. (8.7%) and Enterococcus spp. (6.6%). E. coli and Klebsiella spp. with extended-spectrum beta-lactamases (13% of the total isolated) were associated with the previous use of antibiotics, community care treatment and a permanent urinary catheter (P<.05). The empirical treatment was adequate only in 73.6% of cases. As these treatments were associated with higher mortality, they were not considered adequate. CONCLUSIONS: In the elderly, UTIs show a high mortality. Empirical treatment is often inadequate and may be associated with increased mortality.
INTRODUCTION:Urinary tract infections (UTIs) are one of the most frequent infections. In the elderly, they have multiple comorbidities. The objective of this work is to describe the clinical and microbiological epidemiology of elderly persons admitted for UTIs and to evaluate the suitability of empirical treatments and their implications regarding mortality. MATERIAL AND METHODS: An observational study was conducted during 2013-2015 in 4public hospitals, with patients older than 65 years who were admitted to the Internal Medicine service with a microbiological diagnosis of UTI. Cases of asymptomatic bacteriuria were excluded. In-hospital mortality was analyzed. Univariate analysis and multivariate analysis was carried out. RESULTS: A total of 349 episodes were selected, with a mean age of 82 ± 11 years, 51% female. Mortality was 10.3% and was associated with age, dementia and sepsis and septic shock (P<.05). The most frequent organisms were Escherichia coli(E. coli) (53.6%), Klebsiella spp. (8.7%) and Enterococcus spp. (6.6%). E. coli and Klebsiella spp. with extended-spectrum beta-lactamases (13% of the total isolated) were associated with the previous use of antibiotics, community care treatment and a permanent urinary catheter (P<.05). The empirical treatment was adequate only in 73.6% of cases. As these treatments were associated with higher mortality, they were not considered adequate. CONCLUSIONS: In the elderly, UTIs show a high mortality. Empirical treatment is often inadequate and may be associated with increased mortality.
Authors: E Álvarez Artero; A Campo Núñez; M Garcia Bravo; I García García; M Belhassen Garcia; J Pardo Lledías Journal: Rev Esp Quimioter Date: 2021-04-15 Impact factor: 1.553
Authors: Domingo Palacios-Ceña; Lidiane Lima Florencio; Valentín Hernández-Barrera; Cesar Fernandez-de-Las-Peñas; Javier de Miguel-Diez; David Martínez-Hernández; David Carabantes-Alarcón; Rodrigo Jimenez-García; Ana Lopez-de-Andres; Marta Lopez-Herranz Journal: J Clin Med Date: 2021-05-26 Impact factor: 4.241