Abstract
Urinary tract infection and asymptomatic bacteriuria are common in older adults. Unlike in younger adults, distinguishing symptomatic urinary tract infection from asymptomatic bacteriuria is problematic, as older adults, particularly those living in long-term care facilities, are less likely to present with localized genitourinary symptoms. Consensus guidelines have been published to assist clinicians with diagnosis and treatment of urinary tract infection; however, a single evidence-based approach to diagnosis of urinary tract infection does not exist. In the absence of a gold standard definition of urinary tract infection that clinicians agree upon, overtreatment with antibiotics for suspected urinary tract infection remains a significant problem, and leads to a variety of negative consequences including the development of multidrug-resistant organisms. Future studies improving the diagnostic accuracy of urinary tract infections are needed. This review will cover the prevalence, diagnosis and diagnostic challenges, management, and prevention of urinary tract infection and asymptomatic bacteriuria in older adults.
Highlights
Urinary tract infection and asymptomatic bacteriuria are common in older adults
The definition of a symptomatic Urinary tract infection (UTI) generally requires the presence of urinary tract-specific symptoms in the setting of significant bacteriuria with a quantitative count of ≥105 colony forming units of bacteria per milliliter (CFU/ml) in one urine specimen [2,3]
Asymptomatic bacteriuria (ASB) is defined as the presence of bacteria in the urine, without clinical signs or symptoms suggestive of a UTI [2]
Summary
The incidence of UTI is higher in women compared with men across all age groups. UTI is frequent in young sexually active women with reported incidence rates ranging from 0.5 to 0.7 per person-year [8], while in young men aged 18–24, the reported incidence of UTI is 0.01 per person-year [9]. Over 10% of women older than 65 years of age reported having a UTI within the past 12 months [11]. This number increases to almost 30% in women over the age of 85 years [12]. In a large prospective cohort study of post-menopausal women living in the community, the incidence of UTI was 0.07 per person-year and 0.12 per person-year in older women with diabetes [10]. For men aged 65–74 years, the incidence of UTI is estimated to increase to 0.05 per person-year [9]. A small cohort study in this age group found the incidence of UTI in women to be 0.13 per person-year and 0.08 per person-year in men [13]. Differentiating UTI from ASB is difficult and misclassification may occur
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