Abstract
(1) Background: To assess time trends in the incidence and in-hospital outcomes of urinary tract infection (UTI) in older people (≥65 years) in Spain (2001–2018) according to sex and to identify the factors independently associated with in-hospital mortality (IHM). (2) Methods: Using the Spanish National Hospital Database, we analyzed comorbidity, procedures, diagnosis, isolated microorganisms, and outcomes. (3) Results: We included 583,693 admissions (56.76% women). In both sexes, the incidence increased with age over time (p < 0.001). In men and women, the highest IHM was found among the oldest patients (>84 years) with values of 9.16% and 8.6%, respectively. The prevalence of bacteremia increased from 4.61% to 4.98% from 2001 to 2018 (p < 0.001) and sepsis decreased from 3.16% to 1.69% (p < 0.001). The risk of dying increased with age (>84 years) (OR 3.63; 95% CI 3.5–3.78) and with almost all comorbidities. Urinary catheter was a risk factor for women (OR 1.1; 95% CI 1.02–1.18) and protective for men (OR 0.71; 95% CI 0.66–0.76). Isolation of Staphylococcus aureus increased the risk of IHM by 40% among men (OR 1.4; 95% CI 1.28–1.53). After adjusting for confounders, IHM decreased over time. (4) Conclusions: The incidence of UTIs was higher in older patients and increased over time; however, IHM decreased during the same period. Female sex, age, comorbidities, sepsis, and a Staphylococcus aureus isolation increased risk of IHM.
Highlights
The objectives of the current study were: 1, to describe and analyze the incidence from 2001 to 2018 of urinary tract infection (UTI) hospitalizations according to sex, comorbidities and isolated pathogens, bacteremia, and sepsis among Spanish older people; 2, to assess time trends in hospital outcome variables such as in-hospital mortality (IHM), and 3, to identify the factors independently associated with IHM among older men and women
The incidence increased with age in all time periods for men, women, and both genders
We found that Escherichia coli was the most prevalent pathogen in both sexes regarding isolated pathogens, which is in line with previous reports [1,7,26,28,33,34,35]
Summary
UTI incidence increases with age and is an important cause of antibiotic use, morbidity, and mortality in older adults [3]. UTIs in older women (>65) are seen at approximately double the rate of that in the female population overall [3]. It is estimated that, at a global level, after 65 years of age in noninstitutionalized people, the rate of UTI was 10.9% for men and 14% for women [4]. Other factors predisposing to UTIs include estrogen deficiency and immune senescence [8], bed rest, hospitalizations, long-term medical institutionalization [5,6,7,8,10], iatrogenic factors, including anticholinergic agents, antibiotics, and the presence of urinary catheters [6,8]
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