Abstract
The ageing of the population—especially in developed countries—has brought on many societal challenges and has significantly contributed to the burden on healthcare infrastructures worldwide. Elderly persons (aged ≥ 65 years) are at higher risk for developing UTIs, due to a range of intrinsic and extrinsic risk factors, and they often delay seeking treatment. A retrospective observational study was performed regarding the epidemiology and resistance of UTIs in elderly patients. Identification of the isolates was carried out using VITEK 2 ID/AST and MALDI-TOF mass spectrometry. Antibiotic resistance in these isolates was assessed based on EUCAST guidelines, and were grouped into the WHO AWaRe (Access, Watch, Reserve) classification of antimicrobials. During the 10-year study period, n = 4214 (421.4 ± 118.7/year) and n = 4952 (495.2 ± 274.6) laboratory-confirmed UTIs were recorded in inpatients and outpatients, respectively. The causative agents showed differentiation among outpatients and inpatients: Escherichia coli (48.14% vs. 25.65%; p = 0.001), Enterococcus spp. (20.15% vs. 21.52%; p > 0.05), Klebsiella spp. (16.28% vs. 16.26%; p > 0.05), Pseudomonas spp. (4.40%vs. 13.36%; p = 0.001); Proteus-Providencia-Morganella group (4.56% vs. 10.96%; p = 0.001); Candida spp. (0.53% vs. 5.98%; p = 0.001); Citrobacter-Enterobacter-Serratia group (1.90% vs. 2.71%; p < 0.05). Significantly higher resistance rates were observed in inpatient isolates for many Access and Watch antibiotics compared to isolates of outpatient origin; in addition, resistance rates were higher in these uropathogens compared to the previously recorded rates in the region. More care should be taken for the diagnosis and treatment of UTIs affecting elderly patients, as they represent a particularly vulnerable patient population.
Highlights
Urinary tract infections (UTIs) are one of the commonly encountered infectious pathologies worldwide, with ~120–150 million cases each year, being the most common reason to visit a primary care physician [1]
Members of the Enterobacterales order are the facultative pathogens most commonly implicated as causative agents for UTIs in the general population
Elderly individuals are sensitive to the development of UTIs, due to agerelated physiological changes, emergence of bacteriuria, high prevalence of comorbidities and frequent hospitalization of these patients [18,19]
Summary
Urinary tract infections (UTIs) are one of the commonly encountered infectious pathologies worldwide, with ~120–150 million cases each year, being the most common reason to visit a primary care physician [1]. Community-associated UTIs as well as healthcare-associated UTIs represent a major factor of morbidity worldwide These infections lead to decreased quality of life in the affected patients and are frequently associated with recurrence or sequelae, even if the appropriate antimicrobial therapy was administered [2,3]. Members of the Enterobacterales order are the facultative pathogens most commonly implicated as causative agents for UTIs in the general population. These microorganisms possess an advantageous mix of physiological adaptability and the relevant virulence factors (such as a polysaccharide capsule, urease enzyme, fimbriae, pili) to withstand the sheer forces and to thrive on the urinary epithelium [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
