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Urinary Tract Infections in the Older Adult

  • Lindsay E. Nicolle
    Correspondence
    Department of Medical Microbiology, Health Sciences Centre, University of Manitoba, Room GG443, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
    Affiliations
    Department of Internal Medicine, Health Sciences Centre, University of Manitoba, Room GG443, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada

    Department of Medical Microbiology, Health Sciences Centre, University of Manitoba, Room GG443, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
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Published:April 18, 2016DOI:https://doi.org/10.1016/j.cger.2016.03.002

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      References

        • Nicolle L.E.
        Urinary tract infection in the elderly.
        Clin Geriatr Med. 2009; 25: 423-436
        • Nicolle L.E.
        • Bradley S.
        • Colgan R.
        • et al.
        Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.
        Clin Infect Dis. 2005; 40: 643-654
        • Nicolle L.E.
        Catheter-related urinary tract infection: practical management in the elderly.
        Drugs Aging. 2014; 31: 1-10
        • Rodhe N.
        • Lofgren S.
        • Matussek A.
        • et al.
        Asymptomatic bacteriuria in the elderly: high prevalence and high turnover of strains.
        Scand J Infect Dis. 2008; 40: 804-810
        • Jackson S.L.
        • Boyko E.J.
        • Scholes D.
        • et al.
        Predictors of urinary tract infection after menopause: a prospective study.
        Am J Med. 2004; 117: 903-911
        • Caljouw M.A.
        • den Elzen W.P.
        • Cools H.J.
        • et al.
        Predictive factors of urinary tract infections among the oldest old in the general population: a population-based prospective follow-up study.
        BMC Med. 2011; 9: 57-64
        • Foxman B.
        • Klemstine K.L.
        • Brown P.D.
        Acute pyelonephritis in US hospitals in 1997: hospitalization and in-hospital mortality.
        Ann Epidemiol. 2003; 13: 144-150
        • Mims A.D.
        • Norman D.C.
        • Yamamura R.H.
        • et al.
        Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings.
        J Am Geriatr Soc. 1990; 38: 1209-1214
        • Griebling T.L.
        Urologic diseases in America project: trends in resource use for urinary tract infections in men.
        J Urol. 2005; 173: 1288-1294
        • Nicolle L.E.
        • Friesen D.
        • Harding G.K.
        • et al.
        Hospitalization from acute pyelonephritis in Manitoba, Canada during the period 1989-1992. Impact of diabetes, pregnancy, and aboriginal origin.
        Clin Infect Dis. 1996; 22: 1051-1056
        • Stevenson K.B.
        • Moore J.
        • Colwell H.
        • et al.
        Standardized infection surveillance in long-term care: interfacility comparisons from a regional cohort of facilities.
        Infect Control Hosp Epidemiol. 2005; 26: 231-238
        • Engelhart S.T.
        • Hanses-Derendorf L.
        • Exner M.
        • et al.
        Prospective surveillance for healthcare-associated infections in German nursing home residents.
        J Hosp Infect. 2005; 60: 46-50
        • Esparcia A.
        • Artero A.
        • Eiros J.M.
        • et al.
        Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections.
        Eur J Intern Med. 2014; 25: 523-527
        • Tal S.
        • Guller V.
        • Levi S.
        • et al.
        Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection.
        J Infect. 2005; 50: 296-305
        • Rotjanapan P.
        • Dosa D.
        • Thomas K.S.
        Potential inappropriate treatment of urinary tract infection in two Rhode Island nursing homes.
        Arch Intern Med. 2011; 171: 438-443
        • Mylotte J.M.
        • Tayara A.
        • Goodnough S.
        Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes.
        Clin Infect Dis. 2002; 35: 1484-1490
        • Raz R.
        • Gennesin Y.
        • Wasser J.
        • et al.
        Recurrent urinary tract infections in post-menopausal women.
        Clin Infect Dis. 2000; 30: 152-156
        • Foxman B.
        • Somsel P.
        • Tallman P.
        • et al.
        Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors.
        J Clin Epidemiol. 2001; 54: 710-718
        • Moore E.E.
        • Hawes S.E.
        • Scholes D.
        • et al.
        Sexual intercourse and risk of symptomatic urinary tract infection in post-menopausal women.
        J Gen Intern Med. 2008; 23: 595-599
        • Boyko E.J.
        • Fihn S.D.
        • Scholes D.
        • et al.
        Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women.
        Am J Epidemiol. 2005; 161: 557-564
        • Pabich W.L.
        • Fihn S.D.
        • Stamm W.E.
        • et al.
        Prevalence and determinants of vaginal flora alterations in postmenopausal women.
        J Infect Dis. 2003; 188: 1054-1058
        • Burton J.P.
        • Reid G.
        Evaluation of the bacterial vaginal flora of 20 postmenopausal women by direct (Nugent score) and molecular (polymerase chain reaction and denaturing gradient gel electrophoresis) techniques.
        J Infect Dis. 2002; 186: 1770-1780
        • Raz R.
        • Stamm W.E.
        A controlled trial of intra-vaginal estriol in post-menopausal women with recurrent urinary tract infections.
        N Engl J Med. 1993; 329: 753-757
        • Eriksen B.
        A randomized, open, parallel group study on the preventive effect of an estriol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women.
        Am J Obstet Gynecol. 1999; 180: 1072-1079
        • Hu K.K.
        • Boyko E.J.
        • Scholes D.
        • et al.
        Risk factors for urinary tract infections in postmenopausal women.
        Arch Intern Med. 2004; 164: 989-993
        • Orlander J.D.
        • Jick S.S.
        • Dean A.D.
        • et al.
        Urinary tract infections and estrogen use in older women.
        J Am Geriatr Soc. 1992; 40: 817-820
        • Rodhe N.
        • Molstad S.
        • Englund L.
        • et al.
        Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics, and associated factors.
        Fam Pract. 2006; 23: 303-307
        • Moore E.E.
        • Jackson S.L.
        • Boyko E.J.
        • et al.
        Urinary incontinence and urinary tract infection: temporal relationships in post-menopausal women.
        Obstet Gynecol. 2008; 111: 317-323
        • Stern J.A.
        • Hsieh Y.C.
        • Schaeffer A.J.
        Residual urine in the elderly female population: novel implications for oral estrogen replacement and impact on recurrent urinary tract infection.
        J Urol. 2004; 171: 768-770
        • Truzzi J.C.
        • Almeida F.M.
        • Nunes E.C.
        • et al.
        Residual urinary volume and urinary tract infection—when are they linked?.
        J Urol. 2008; 180: 182-185
        • Omli R.
        • Skotnes L.H.
        • Mykletun A.
        • et al.
        Residual urine as a risk factor for lower urinary tract infection: a 1-year follow-up study in nursing homes.
        J Am Geriatr Soc. 2008; 56: 871-874
        • Barabas G.
        • Molstad S.
        No association between elevated post-void residual volume and bacteriuria in residents of nursing homes.
        Scand J Prim Health Care. 2005; 23: 52-56
        • Ouslander J.G.
        • Greengold B.
        • Chen S.
        External catheter use and urinary tract infection among incontinent male nursing home patients.
        J Am Geriatr Soc. 1987; 35: 1063-1070
        • Vogel T.
        • Verreault R.
        • Gourdeau M.
        • et al.
        Optimal duration of antimicrobial therapy for uncomplicated urinary tract infection in older women: a double-blind, randomized controlled trial.
        CMAJ. 2004; 170: 469-473
        • Boyko E.J.
        • Fihn S.D.
        • Scholes D.
        • et al.
        Diabetes and the risk of acute urinary tract infection among postmenopausal women.
        Diabetes Care. 2002; 25: 1778-1783
        • Colodner R.
        • Kometiani I.
        • Chazan B.
        • et al.
        Risk factors for community-acquired urinary tract infection due to quinolone-resistant E. coli.
        Infection. 2008; 36: 41-45
        • Smithson A.
        • Chico C.
        • Ramos J.
        • et al.
        Prevalence and risk factors for quinolone resistance among Escherichia coli strains isolated from males with community febrile urinary tract infection.
        Eur J Clin Microbiol Infect Dis. 2012; 31: 423-430
        • van Duin D.
        • Cober E.
        • Richter S.S.
        • et al.
        Residence in skilled nursing facilities is associated with tigecycline non-susceptibility in carbapenem-resistant Klebsiella pneumoniae.
        Infect Control Hosp Epidemiol. 2015; 36: 942-948
        • Das R.
        • Towle V.
        • Van Ness P.H.
        • et al.
        Adverse outcomes in nursing home residents with increased episodes of observed bacteriuria.
        Infect Control Hosp Epidemiol. 2011; 32: 84-86
        • Van der Donk C.F.
        • Schols J.M.
        • Driessen C.J.
        • et al.
        Prevalence and spread of multidrug resistant Escherichia coli isolates among nursing home residents in the southern part of The Netherlands.
        J Am Med Dir Assoc. 2013; 14: 199-203
        • High K.P.
        • Bradley S.F.
        • Gravenstein S.
        • et al.
        Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities.
        Clin Infect Dis. 2009; 48: 149-171
        • Nicolle L.E.
        • SHEA Long-Term-Care-Committee
        Urinary tract infections in long-term care facilities.
        Infect Control Hosp Epidemiol. 2001; 22: 167-175
        • Stone N.D.
        • Ashraf M.S.
        • Calder J.
        • et al.
        Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria.
        Infect Control Hosp Epidemiol. 2012; 33: 965-977
        • Juthani-Mehta M.
        • Quagliarello V.
        • Perrelli E.
        • et al.
        Clinical features to identify urinary tract infection in nursing home residents: a cohort study.
        J Am Geriatr Soc. 2009; 57: 963-970
        • Rowe T.
        • Towle V.
        • Van Ness P.H.
        Lack of positive association between falls and bacteriuria plus pyuria in older nursing home residents.
        J Am Geriatr Soc. 2013; 61: 653-654
        • Sundvall P.D.
        • Ulleryd P.
        • Gunnarsson R.K.
        Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes.
        BMC Fam Pract. 2011; 12: 36
        • Laurila J.V.
        • Laakkonen M.L.
        • Tilvis R.S.
        • et al.
        Predisposing and precipitating factors for delirium in a frail geriatric population.
        J Psychosom Res. 2008; 65: 249-254
        • Boockvar K.
        • Signor D.
        • Ramaswamy R.
        • et al.
        Delirium during acute illness in nursing residents.
        J Am Med Dir Assoc. 2013; 14: 656-660
        • Eriksson I.
        • Gustafson Y.
        • Fagerstrom L.
        • et al.
        Urinary tract infection in very old women is associated with delirium.
        Int Psychogeriatr. 2011; 23: 496-502
        • Drinka P.
        Does urinary infection cause residents’ mental status change?.
        J Am Geriatr Soc. 2009; 57: 2387-2388
        • D’Agata E.
        • Loeb M.B.
        • Mitchell S.L.
        Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections.
        J Am Geriatr Soc. 2013; 61: 62-66
        • Loeb M.
        • Bentley D.W.
        • Bradley S.
        • et al.
        Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference.
        Infect Control Hosp Epidemiol. 2001; 22: 120-124
        • Loeb M.
        • Brazil K.
        • Lohfeld L.
        • et al.
        Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomized controlled trial.
        BMJ. 2005; 331: 669
        • Nace D.A.
        • Drinka P.J.
        • Crnich C.J.
        Clinical uncertainties in the approach to long term care residents with possible urinary tract infection.
        J Am Med Dir Assoc. 2014; 15: 133-139
        • Lipsky B.A.
        Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis and treatment.
        Ann Intern Med. 1989; 110: 138-150
        • Rodhe N.
        • Lofgren S.
        • Strindhall J.
        • et al.
        Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria.
        Scand J Prim Health Care. 2009; 27: 74-79
        • Sundvall P.D.
        • Elm M.
        • Ulleryd P.
        • et al.
        Interleukin-6 concentrations in the urine and dipstick analyses were related to bacteriuria but not symptoms in the elderly: a cross sectional study of 421 nursing home residents.
        BMC Geriatr. 2014; 14: 88
        • Gomolin I.H.
        • Siami P.F.
        • Reuning-Scherer J.
        • et al.
        Efficacy and safety of oral ciprofloxacin suspension versus trimethoprim-sulfamethoxazole oral suspension for treatment of older women with acute urinary tract infection.
        J Am Geriatr Soc. 2001; 49: 1606-1613
        • Penrotta C.
        • Aznar M.
        • Mejia R.
        • et al.
        Oestrogens for preventing recurrent urinary tract infections in post-menopausal women.
        Cochrane Database Syst Rev. 2008; (CD005131)
        • Raz R.
        • Colodner R.
        • Rohana Y.
        • et al.
        Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women.
        Clin Infect Dis. 2003; 36: 1362-1368
        • McMurdo M.E.
        • Argo I.
        • Phillips G.
        • et al.
        Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women.
        J Antimicrob Chemother. 2009; 63: 389-395
        • McMurdo M.E.
        • Bissett L.Y.
        • Price R.J.
        • et al.
        Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? A double-blind, placebo-controlled trial.
        Age Ageing. 2005; 34: 256-261
        • Beerepoot M.A.
        • ter Riet G.
        • Nys S.
        • et al.
        Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized double-blind, noninferiority trial in post-menopausal women.
        Arch Intern Med. 2012; 172: 704-712
        • Ouslander J.G.
        • Greendale G.A.
        • Uman G.
        • et al.
        Effects of oral estrogen and progestin on the lower urinary tract among female nursing home residents.
        J Am Geriatr Soc. 2001; 49: 803-807
        • Juthani-Mehta M.
        • Perley L.
        • Chen S.
        • et al.
        Feasibility of cranberry capsule administration and clean-catch urine collection in long-term care residents.
        J Am Geriatr Soc. 2010; 58: 2028-2029
        • Bianco L.
        • Perrelli E.
        • Towle V.
        • et al.
        Pilot randomized controlled dosing study of cranberry capsules for reduction of bacteriuria plus pyuria in female nursing home residents.
        J Am Geriatr Soc. 2012; 60: 1180-1181
        • Rogers M.A.M.
        • Mody L.
        • Kaufman S.R.
        • et al.
        Use of urinary collection devices in skilled nursing facilities in five states.
        J Am Geriatr Soc. 2008; 56: 854-861
        • Jonsson K.
        • E-son Loft A.L.
        • Nasic S.
        • et al.
        A prospective registration of catheter life and catheter interventions in patients with long-term indwelling urinary catheters.
        Scand J Urol Nephrol. 2011; 45: 401-405
        • Wang L.
        • Lansing B.
        • Symons K.
        • et al.
        Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility residents with indwelling devices.
        Eur J Clin Microbiol Infect Dis. 2012; 31: 1797-1804
        • Warren J.W.
        Catheter-associated urinary tract infections.
        Infect Dis Clin North Am. 1997; 11: 609-622
        • Muder R.R.
        • Brennen C.
        • Wagener M.M.
        • et al.
        Bacteremia in a long-term-care facility: a five-year prospective study of 163 consecutive episodes.
        Clin Infect Dis. 1992; 14: 647-654
        • Rudman D.
        • Hontanosas A.
        • Cohen Z.
        • et al.
        Clinical correlates of bacteremia in a veterans administration extended care facility.
        J Am Geriatr Soc. 1988; 36: 726-732
        • Jonsson K.
        • Claesson B.E.
        • Hedelin H.
        Urine cultures from indwelling bladder catheters in nursing home patients: a point prevalence study in a Swedish county.
        Scand J Urol Nephrol. 2011; 45: 265-269
        • Warren J.W.
        • Tenney J.H.
        • Hoopes J.M.
        • et al.
        A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters.
        J Infect Dis. 1982; 146: 719-723
        • Jacobsen S.M.
        • Stickler D.J.
        • Mobley H.L.
        • et al.
        Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis.
        Clin Microbiol Rev. 2008; 21: 26-59
        • Han J.H.
        • Maslow J.
        • Han X.
        • et al.
        Risk factors for the development of gastrointestinal colonization with fluoroquinolone-resistant Escherichia coli in residents of long-term care facilities.
        J Infect Dis. 2014; 209: 420-425
        • Raz R.
        • Schiller D.
        • Nicolle L.E.
        Chronic indwelling catheter replacement prior to antimicrobial therapy for symptomatic urinary infection.
        J Urol. 2000; 164: 1254-1258
        • Steward D.K.
        • Wood G.L.
        • Cohen R.L.
        • et al.
        Failure of the urinalysis and quantitative urine culture in diagnosing symptomatic urinary tract infections in patients with long-term urinary catheters.
        Am J Infect Control. 1985; 13: 154-160
        • Gould C.V.
        • Umscheid C.A.
        • Agarwal R.K.
        • et al.
        Guideline for prevention of catheter-associated urinary tract infections 2009.
        Infect Control Hosp Epidemiol. 2010; 31: 319-326
        • Lo E.
        • Nicolle L.E.
        • Coffin S.E.
        • et al.
        Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update.
        Infect Control Hosp Epidemiol. 2014; 35: S32-S48
        • Saint S.
        • Kaufman S.R.
        • Rogers M.A.
        • et al.
        Condom versus indwelling urinary catheters: a randomized trial.
        J Am Geriatr Soc. 2006; 54: 1055-1061
        • Mody L.
        • Saint S.
        • Galecki A.
        • et al.
        Knowledge of evidence-based urinary catheter care practice recommendations among healthcare workers in nursing homes.
        J Am Geriatr Soc. 2010; 58: 1532-1537