Chapter 13 - Urinary tract infection in old age

Abstract

Publisher Summary This chapter discusses the issue of urinary tract infection (UTI) in old age. UTI is common at all ages, but its prevalence increases with advancing age, with institutionalization, and with the female sex. In the elderly, clinical presentation is often unusual, for instance, with the symptoms of mental confusion or incontinence. Also, much infection is asymptomatic and when discovered its management poses problems. The chapter discusses the prevalence of UTI in non-institutionalized old people, where it is compared with prevalence in younger age groups. Overall the prevalence in old people living in the community is between 15 percent and 20 percent. This figure increases among the institutionalized and especially the group of old people living in long-stay hospital wards. In men, recurrent UTI is almost exclusively a problem of the over 50s and is found particularly with coexisting medical disease, including diabetes mellitus and essential hypertension. Radiographic studies identify structural abnormalities in the kidneys in approximately half of these patients, including pyelonephritic scarring and renal calculi. Escherichia coli causes the great majority of recurrent urinary tract infections that develop in men in the absence of urethral catheters or ileal loop bladders. In women, most recurrence is caused by E. coli and appears to be reinfection rather than relapse and the bladder is the usual site of infection. There is evidence of a good correlation between the past history of UTI and the presence of significant bacteriuria.