Elderly urinary tract infections

Perform urinalysis, urine toxicology, thyroid function, and white blood cell count in the elderly to rule out urinary tract infection... 

Delirium is characterized by a disturbance of consciousness and a change in cognition that develops over a short period of time, usually hours or days. The course can fluctuate over the course of the day, usually worsening in the evening. Underlying medical problems such as urinary tract infections in the elderly, substance abuse, or withdrawal symptoms in adults may precipitate delirium.1... 

Elderly E. coli [secondary to urinary tract infections (UTIs)]... 

Elderly Advanced age was associated with a decrease of tiotropium renal clearance, which may be explained by decreased renal function. In the placebo-controlled studies, a higher frequency of dry mouth, constipation, and urinary tract infections was observed with increasing age in the tiotropium group. Pregnancy Category C. 

Adverse reactions occurring in 3% or more of elderly patients include abnormal dreams, accidental injury, diarrhea, dizziness, dry mouth, dyspepsia, headache, neuralgia, pain, pruritus, unpleasant taste, urinary tract infection. 

Delirium is a clinical diagnosis, based on the recent and abrupt appearance of clouded consciousness, with disorientation in time, and then in place and person. The patient can appear perplexed at first, gradually becoming frankly paranoid and aggressive, often with visual hallucinations. In elderly patients without clear localizing signs, acute toxic confusion is most often related to urinary tract infection. 

Urinary tract infections can be classified by anatomic site of involvement into lower and upper urinary tract infections. Lower UTls include cystitis, urethritis, prostatitis, and epididymitis, whereas upper urinary tract infections include pyelonephritis. UTls also may be further classified as complicated or uncomplicated. In females with a structurally normal urinary tract, both cystitis and pyelonephritis are considered uncomplicated UTls. UTls in men, elderly individuals, pregnant women, or patients with in-dwelling... 

Baldassarre JS, Kaye D. Special problems in urinary tract infections in the elderly. Med Clin North Am 1991 75 375-390. 

The use of TMP-SMZ has been recently associated with the appearance of hifperkalerma. The patients either had AIDS and were receiving large doses of TMP-SMZ for the treatment of PCP [107-109] or were elderly subjects without either AIDS or PCP treated for respiratory or urinary tract infections with standard doses [110,110a, 111]. The hyperkalemia is mild (rarely exceeding 6.5 mEq/L) and reversible on discontinuation of the drug. It appears that in patients without AIDS, hyperkalemia must be very rare since no case of... 

Escherichia coli is found in the intestines of humans and other warm-blooded animals where it performs important physiological functions [28]. They are not normally found living in other enviromnents, but have been reported to multiply in surface waters, especially in tropical environments. Several strains of E. coli are usually nondisease causing, although illnesses such as septicemia and urinary tract infections have been reported, especially in immunocompromised individuals. Some E. coli strains (e.g., E. coli 0157 H7) produce toxins that may cause diarrhea or even death in humans, particularly in elderly people and children [131]. 

Moxifloxacin-induced rhabdomyolysis was reported in an elderly female admitted to ICU following a left cerebellar stroke. A urinary tract infection was treated for 4 days with intravenous moxifloxacin (400 mg). She subsequently developed typical rhabdomyolysis symptoms including myalgia and dark-coloured urine. A serum creatinine phos-phokinase measured 61,000 U/L. Cessation of the antibiotic and alkaline diuresis resolves the problem [59 ]. 

Several age-related changes contribute to the high incidence of infections in geriatric patients. There appears to be a reduction in host defenses in the elderly, manifested in the increase in both serious infections and cancer. This may reflect an alteration in T-lymphocyte function. In the lungs, a major age and tobacco-dependent decrease in mucociliary clearance significantly increases susceptibility to infection. In the urinary tract, the incidence of serious infection is greatly increased by urinary retention and catheterization in men. 

This may be found by routine urine testing of pregnant women or patients with known structural abnormalities of the urinary tract. Such infection may explain micturition frequency or incontinence in the elderly. Appropriate antimicrobial therapy should be given, chosen on the basis of susceptibility tests, and normally for 7-10 days. Amoxicillin or a cephalosporin is preferred in pregnancy, although nitrofurantoin may be used if imminent delivery is not likely (see below). 

Elderly patients frequently do not experience specific urinary symptoms, but they will present with altered mental status, change in eating habits, or gastrointestinal symptoms. In addition, patients with indwelling catheters or neurologic disorders commonly will not have lower tract symptoms, whereas flank pain and fever may be recognized. Many of the aforementioned patients, however, frequently will develop upper tract infections with bacteremia and no or minimal urinary tract symptoms. 

In elderly males, benign hypertrophy of the prostate is of great clinical importance. It results in urinary obstruction, secondary changes in the urinary tract due to back pressure and risks of secondary infection. Chemotherapy of this condition is attractive as surgery is not always practicable in elderly. patients. 

---