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Urinary tract infection at the age extremes: pediatrics and geriatrics
Linda M Dairiki Shortliffe1, Jack D McCue
1Department of Urology, Stanford University School of Medicine, California 94305-5118, USA.
Insights
Urinary tract infections (UTIs) present differently in pediatric and geriatric populations compared to young adults. Management strategies must be tailored to age-specific risks and complications for effective treatment.
Area of Science:
- Urology
- Pediatrics
- Geriatrics
Background:
- Urinary tract infections (UTIs) are common in young, sexually active women but can be severe in infants, young children, and the elderly.
- Pediatric UTIs may lead to significant morbidity and require extensive imaging to detect abnormalities.
- Geriatric UTIs are complicated by comorbidities, asymptomatic bacteriuria, and diagnostic challenges.
Purpose of the Study:
- To highlight the distinct characteristics and management of UTIs in pediatric and geriatric populations.
- To emphasize the need for age-specific diagnostic and treatment approaches for UTIs.
Main Methods:
- Review of current literature on UTI management in different age groups.
- Analysis of complications, diagnostic considerations, and treatment strategies for pediatric and geriatric UTIs.
Main Results:
- Pediatric UTIs require prompt evaluation and often parenteral antibiotics, with oral options like trimethoprim-sulfamethoxazole (TMP-SMX) for less severe cases.
- Geriatric UTIs involve a broader range of pathogens, necessitating conservative management with longer treatment durations and broad-spectrum agents.
- Fluoroquinolones are preferred for 7-day empiric treatment in older adults, with TMP-SMX as an option if sensitivity is confirmed.
Conclusions:
- UTIs in the very young and elderly are complicated and require specialized management distinct from that in young adults.
- Tailoring treatment based on age, comorbidities, and pathogen profile is crucial for optimal outcomes in pediatric and geriatric UTIs.
Abstract:
Urinary tract infections (UTIs) are common and generally benign conditions among healthy, sexually active young women without long-term medical sequelae. In contrast, UTIs are more complicated among those individuals at either end of the age spectrum: infants/young children and geriatrics. UTI in children younger than 2 years has been associated with significant morbidity and long-term medical consequences, necessitating an extensive and somewhat invasive imaging evaluation to identify possible underlying functional or anatomic abnormalities. Pediatric UTI should be considered complicated until proved otherwise, and treatment should reflect the severity of signs and symptoms. Management in the acutely ill child frequently involves parenteral broad-spectrum antimicrobial agents, and less ill children can be treated with trimethoprim- sulfamethoxazole (TMP-SMX), beta-lactams, and cephalosporins.UTI among older patients (>65 years) may be complicated by comorbidities, the baseline presence of asymptomatic bacteriuria, and benign urinary symptoms that can complicate diagnosis. The etiology of UTI encompasses a broader spectrum of infecting organisms than is seen among younger patients and includes more gram-positive organisms. Symptomatic UTI is generally more difficult to treat than among younger populations. Management should be conservative, of longer treatment durations, and cover a broad spectrum of possible uropathogens. Oral or parenteral treatment with a fluoroquinolone for 7 days is the preferred empiric approach. TMP-SMX can also be considered a first-line agent in women only, but only if the pathogen is known to be TMP-SMX sensitive.