Urinary tract infections are common in the elderly population, with an incidence of about 7-10%. It is the second most common infectious disease in the elderly, after respiratory tract infections. There is an increasing trend with age, and the gap between male and female prevalence is narrowing.
A. Reasons for the high incidence of urinary tract infections in the elderly
1, the bladder response to urine pressure is reduced, the incidence of neurogenic or weak bladder is higher, the residual urine increases or urinary retention causes increased pressure in the bladder, and the local antimicrobial power is reduced.
2, poor urinary flow or obstruction, such as prostate hypertrophy, urinary tract tumors, urethral diverticula, urinary stones, urinary tract dysfunction, etc., so that urinary tract obstruction, easy to cause urinary tract infection.
3, systemic immune function, poor nutrition, poor perineal cleanliness and hygiene, and reduced resistance to various pathogens.
4, antibacterial activity is reduced
The majority of elderly men have prostate hypertrophy, with ageing prostate fluid in certain ionic components such as zinc, magnesium, calcium content and PH value changes, can affect its antibacterial activity, complicating urinary tract infections. In elderly women, the decrease in estrogen, degenerative changes in the urethral mucosa; weak urethral sphincter, urinary incontinence, perineal contamination, bacterial parasitism in the urethral orifice; rising pH value of vaginal secretions after menopause, difficulty in inhibiting the growth of urinary tract bacteria, all cause intractable urinary tract infections.
The elderly are often combined with cerebrovascular accidents, impaired limb movement, dementia, difficulty in urination requiring indwelling urinary catheters, and chronic diseases such as diabetes, malignancy, chronic renal insufficiency, and fractures, resulting in long-term bed rest and malnutrition; at the same time, repeated use of broad-spectrum antimicrobials for infections leads to infection with conditionally pathogenic bacteria.
Pathogenic characteristics of the pathogens of geriatric urinary tract infections
The most common pathogenic bacteria are Gram-negative bacilli, mainly Escherichia coli and Aspergillus, followed by Pseudomonas aeruginosa, Klebsiella, etc. In recent years, Gram-positive cocci such as Staphylococcus and Enterococcus are also more common than before.
Second, the clinical symptoms of urinary tract infection in the elderly are mostly atypical
1, urinary tract irritation symptoms (urinary frequency, urinary urgency, urinary pain) accounted for only 35%, some patients showed urinary incontinence; resulting in the diagnosis of urinary tract infection is ignored.
2, systemic symptoms are more obvious, such as chills, fever, headache, nausea or acute abdominal pain, severe cases can produce sepsis, toxic shock; there is also the performance of apathy, irritability, anorexia and personality changes.
3, urine test can find a large number of white blood cells, pus cells, red blood cells and bacteria.
4.High recurrence rate and reinfection rate.
Urinary tract infections are divided into lower urinary tract infections (urethritis, cystitis) and upper urinary tract infections (ureteritis, pyelonephritis). Lower urinary tract infections can exist alone, while upper urinary tract infections mostly coexist with lower urinary tract infections.
Diagnostic points of urinary tract infection in the elderly
Diagnosis mainly relies on medical history and urine examination, with clinical manifestations such as urinary tract irritation symptoms and urine leukocytes exceeding 5/high magnification field, which are to be considered. Pathogenic diagnosis is established on the basis of the initial clinical diagnosis, leaving a mid-phase urine culture with >105 colony-forming units per ml of urine bacteria is diagnostic; it is more meaningful if repeated examinations are of the same pathogen; drug sensitivity is also made.
For recurrent urinary tract infections it is still necessary to check for the presence of primary pathologies such as obstructive nephropathy, stones, tumors, abscesses, or anatomical abnormalities of the genitourinary tract. Chronic bacterial prostatitis is a common cause of recurrent urinary tract infections in older men, and the diagnosis is based on a colony count in the urine or prostate fluid that is at least 10 times greater than the count in the urine extract sample. In addition, the presence of neutrophils in the secretions of the prostate also helps in the diagnosis.
IV. Treatment of urinary tract infections in the elderly
The treatment of urinary tract infection is determined by the comprehensive formulation of localized diagnosis, type of bacteria, and severity of toxic symptoms. Actively treat the underlying disease and remove the predisposing factors.
1, general symptomatic treatment, fever should be bed rest, drink more water, more urination, urinary tract obstruction should try to release the obstruction, keep the urine drainage smooth. The use of estrogen in postmenopausal women can restore the physiological state of the lower urinary tract, vaginal PH and the relationship between the flora and the bacteria, and reduce symptoms.
2.Rational use of antimicrobial therapy.
(1) Asymptomatic bacteriuria advocates short-course therapy, single-dose tonics method. Furantoin, haloperidol, amoxicillin or cefadroxil, any one of them can be taken at bedtime. Also available is 1 tablet each of cotrimoxazole and sodium bicarbonate, to be taken in one dose.
(2) For symptomatic cystitis and women patients tend to 7 days therapy, men generally 14 days.
(3) For complex urinary tract infections, such as pyelonephritis, there are mostly structural or functional abnormalities of the urinary tract, or systemic diseases, which should be treated in the hospital to eliminate and correct the above factors, which is the key to complete control of the infection and prevent recurrence. The antimicrobial agent must be selected according to the drug sensitivity, and the antimicrobial agent must be a stronger drug or a combination of two drugs. In severe cases, the drug should be given intravenously and can be given orally after it becomes effective. Chronic recurrent patients, after the control of acute attacks, long-term small doses of traffic oh, intermittent use of antimicrobials to consolidate the efficacy of the course of 1-3 months. After the urinary bacteria turn negative, pay attention to the review and monitoring to prevent relapse.
3. Asymptomatic bacteriuria does not require treatment
Asymptomatic bacteriuria refers to 1-2 weeks, 2 times in the middle urine culture of a certain bacteria > 105 colony-forming units, but no symptoms, not long lasting, mostly seen in older women, if no other coexisting conditions aggravate the symptoms, may not be treated, even if treated, but also often relapse, and easy to lead to the production of drug-resistant strains of bacteria. For men with asymptomatic bacteriuria, further examination should be performed to check the residual urine volume, except for stones and tumors, and then actively treat the disease after identifying the causative factors. In patients with untreated asymptomatic bacteriuria, pathogenic bacteria (especially E. coli) lose their virulence and the bactericidal sensitivity of human plasma increases, so the presence of low virulence bacteria in the urine can instead prevent symptomatic bacteriuria caused by highly virulent strains.
In conclusion, elderly patients should strengthen their care, encourage more water, urinate regularly, pay attention to perineal hygiene, alkalize urine, and help reduce urinary tract irritation and enhance the efficacy of drugs.