Tract Infection In Older Adults Research Articles

Uromodulin in kidney health and disease.

Although uromodulin or Tamm-Horsfall protein was discovered over 60 years ago, its functional role in humans remains unclear. This review highlights new studies elucidating the clinical correlates of uromodulin, its association with kidney function decline, nephrolithiasis and urinary host defense. Uromodulin is evolutionarily conserved and has multiple functional roles. In large population studies, higher levels of uromodulin are associated with higher estimated glomerular filtration rate (eGFR) and kidney size, possibly indicating greater kidney functional reserve. Greater uromodulin excretion is associated with markers of volume overload such as fractional excretion of uric acid, sodium and chloride, indicating a possible role in salt and water retention. Recent evidence also suggests that higher uromodulin levels are associated with lower risk of eGFR decline, death and possibly a lower risk of acute kidney injury. Higher levels of uromodulin are associated with lower risk of urinary tract infections in older adults. Serum uromodulin levels are positively associated with eGFR, although its functional role remains unclear. Over the last decade, we have begun to understand the functional role of uromodulin in health and disease. Large prospective studies in generalizable populations are needed to confirm these preliminary results, evaluate the clinical utility of measuring uromodulin and examine whether levels of this biomarker can be altered for therapeutic benefit.

Life-threatening Interaction Between Renin-angiotensin-aldosterone System Inhibitors and Trimethoprim-sulfamethoxazole in Older Adults

Older adults comprise 13% of the population of the United States and often have multiple chronic diseases that lead to the consumption of numerous prescription medications. Among the diagnoses often affecting older adults are hypertension, diabetes, and chronic kidney disease. Because of these diagnoses and normal physiologic changes of aging, older adults often are prescribed an inhibitor of the renin-angiotensin-aldosterone system, which may increase their risk for hyperkalemia and life-threatening arrhythmias if they are prescribed trimethoprim-sulfamethoxazole for a urinary tract infection. Careful consideration of renal status and medication usage is important when considering antimicrobial treatment for urinary tract infections in older adults.

Urinary tract infection in older adults in long-term care facilities.

There are several approaches to diagnosing urinary tract infection in older adults, with certain common elements in diagnostic criteria. The accepted criteria are two clinical symptoms (from the following list: temperature > 38°C, urinary urgency or frequency, acute dysuria, hypogastric pain,

Predictive value of urinary interleukin-6 for symptomatic urinary tract infections in a nursing home population.

To study urinary interleukin-6, interleukin-8 and pyuria during episodes of asymptomatic bacteriuria and symptomatic urinary tract infection in the institutionalized elderly, and to investigate the role of interleukin-6 as a biomarker for differential diagnosis. Levels of interleukin-6, interleukin-8 and pyuria were assessed in 35 older adults with asymptomatic bacteriuria and symptomatic urinary tract infection to define possible diagnostic thresholds. In a two-phase intervention study, the antibiotic treatment for urinary tract infection before and after introduction of urinary interleukin-6 as a biomarker was then assessed. Asymptomatic bacteriuria patients had no or low levels of interleukin-6, and low levels of interleukin-8 and pyuria. Women had lower interleukin-6 and interleukin-8 than men (P = 0.05). Interleukin-6 was the only marker showing significant increases during urinary tract infection episodes in patients with both asymptomatic bacteriuria and urinary tract infection, in pooled (P = 0.042) and in paired intra-individual (P = 0.017) comparisons. In the intervention study lectures, the increased use of urine cultures and the introduction of interleukin-6 as a biomarker reduced antibiotic treatments by 20%. Antibiotic-treated urinary tract infection episodes had increased interleukin-6 as compared with urinary tract infection episodes not treated (P = 0.02), and as compared with asymptomatic bacteriuria patients (P < 0.0001). The sensitivity and specificity of interleukin-6 (cut-off 25 pg/mL) differentiating asymptomatic bacteriuria from urinary tract infection was 57% and 80%, respectively. Urinary interleukin-6 shows promise as a biomarker to detect the transition from asymptomatic bacteriuria to symptomatic urinary tract infection in older adults. Further larger studies with robust methodology are warranted to determine whether development for near to patient testing would be worthwhile.

Treating urinary tract infection in older adults

Urinary tract infections (UTI) are particularly common in the older population, and assessment and treatment can be complicated. In this article, Alison Bardsley considers the guidelines for diagnosing a UTI

Urinary Tract Infection in Older Adults

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.

Urinary tract infection in older adults

Urinary tract infection in older adults

Diagnostic Challenges and Opportunities in Older Adults With Infectious Diseases

Infections remain a major threat to the well-being of our growing aged population. The correct and timely diagnosis of infections in older adults is increasingly important in the current age of antimicrobial resistance. Urinary tract infection, pneumonia, and bacteremia present particular challenges. In older patients with bacteremia, blood cultures have comparable yield as compared with younger patients. However, the routine triggers for ordering blood cultures may not be appropriate in older adults. In addition, resistance patterns of isolated pathogens may change with age. The main difficulties in diagnosing urinary tract infections in older adults are caused by an increased prevalence of asymptomatic bacteriuria and frequent use of urinary catheters. However, a combined noninvasive approach that includes history, physical examination, urinary dipstick testing, urine cultures, and simple blood tests can provide direction. In addition, specific guidelines for specific populations are available. In older patients suspected of bacterial pneumonia, bedside pulse oximetry and urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila provide direction for the clinician. Although infected older adults pose specific and unique diagnostic challenges, a thorough history and physical examination combined with minimally invasive testing will lead to the correct diagnosis in most older adults with infectious diseases, limiting the need for empiric antibiotics in this age group.

Urinary Tract Infection in Older Adults

Urinary tract infection is common among older adults, although most individuals are asymptomatic. The prevalence of bacteriuria varies significantly with living situation and functional status. Asymptomatic bacteriuria is a benign condition and is not an independent risk factor for mortality in older adults. Treatment of asymptomatic bacteriuria generally is not indicated, but symptomatic urinary tract infection of the lower or upper tract dictates antibiotic therapy.

Urinary Tract Infections in Older Adults

Upper and lower urinary tract infections are common and frequently recurring problems encountered by clinicians who manage the health care of older adults. Due to the multiplicity of diseases in this population, it is sometimes difficult to identify symptoms and diagnose urinary tract infections. Evaluating the presenting symptoms, collecting specimens and interpreting laboratory data can present a challenge. Identifying clients at risk, knowing the client's prior health status, recognizing the symptoms and maintaining updated knowledge of antibiotic therapy remain essential care components. This article reviews the current literature on urinary tract infections and provides guidelines for the treatment of urinary tract infections in the older adult.