Complicated Urinary Tract Infection in the Geriatric Population

Abstract

Complicated urinary tract infection (UTI) is a common problem in the geriatric population. The major complicating factors are frequent use of indwelling catheters and disorders that inhibit complete emptying of the bladder. Infection with antimicrobial-resistant, gram-negative bacilli (GNB) is much more common in those with complicated infection than those with uncomplicated infection. Nitrofurantoin and fosfomycin are the oral agents most likely to retain activity against the very resistant GNB, but Proteus species and Pseudomonas are resistant to nitrofurantoin. The polymyxins and tigecycline are the parenteral agents most likely to retain activity against these organisms, but low serum and urine levels are problematic for tigecycline. Bacteremia is common and the infection may be life-threatening in the presence of pyelonephritis with obstructive uropathy, renal abscess, perinephric abscess, emphysematous pyelonephritis, or emphysematous cystitis. With complicated pyelonephritis, imaging studies are critical and urological consultation and intervention may be necessary, especially if obstructive uropathy or any of the above life-threatening complications is present. With complicated lower tract infection, the goal is relief of symptoms.