Characteristics of febrile urinary tract infections in older male adults
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Published on: December 1, 2017
Alex Smithson1, Javier Ramos2, Esther Niño2
1Infectious Diseases Unit, Fundació Hospital de l'Esperit Sant, C/Avinguda Mossen Pons i Rabadà s/n, 08923, Santa Coloma Gramenet, Spain. asa30412@hotmail.com.
Background:
Urinary tract infections (UTI) are among the most frequent bacterial infections in older adults. The aim of the study was to analyse the existence of differences in clinical features, microbiological data and risk of infection by multidrug-resistant organisms (MDRO) between older and non-older men with febrile UTI (FUTI).
Methods:
This was an ambispective observational study involving older males with a FUTI attended in the Emergency Department. Variables collected included age, comorbidity, diagnostic of healthcare-associated (HCA)-FUTI, clinical manifestations, hospitalization, mortality, and microbiological data.
Results:
Five hundred fifty-two males with a FUTI, 329 (59.6%) of whom were older adults, were included. Older males had a higher frequency of HCA-FUTI (p < 0.001), increased Charlson scores (p < 0.001), had received previous antimicrobial treatment more frequently (p < 0.001) and had less lower urinary tract symptoms (p < 0.001). Older patients showed a lower frequency of FUTI caused by E. coli (p < 0.001) and a higher rate of those due to Enterobacter spp. (p = 0.003) and P. aeruginosa (p = 0.033). Resistance rates to cefuroxime (p = 0.038), gentamicin (p = 0.043), and fluoroquinolones (p < 0.001) in E. coli isolates and the prevalence of extended-spectrum beta-lactamase and AmpC producing E. coli and Klebsiella spp. strains (p = 0.041) and MDRO (p < 0.001) were increased in older males. Inadequate empirical antimicrobial treatment (p = 0.004), frequency of hospitalization (p < 0.001), and all cause in-hospital mortality (p = 0.007) were higher among older patients. In the multivariate analysis, being admitted from an long term care facility (OR 2.4; 95% CI: 1.06-5.9), having a urinary tract abnormality (OR 2.2; 95% CI: 1.2-3.8) and previous antimicrobial treatment (OR 3.2; 95% CI: 1.9-5.4) were associated to FUTI caused by MDRO.
Conclusions:
Older male adults with a FUTI have different clinical characteristics, present specific microbiological features, and antimicrobial resistance rates. In the multivariate analysis being an older male was not associated with an increased risk of FUTI caused by MDRO.
Insights
Older men with febrile urinary tract infections (FUTI) show distinct clinical and microbiological profiles compared to younger patients. While older age itself wasn't linked to multidrug-resistant organism (MDRO) FUTI, factors like prior treatment and comorbidities increased risk.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Urinary tract infections (UTI) are common in older adults.
- Febrile UTI (FUTI) presents unique challenges in this demographic.
- Understanding differences between older and younger men with FUTI is crucial for effective management.
Purpose of the Study:
- To compare clinical features, microbiological data, and risk of multidrug-resistant organism (MDRO) infection in older versus non-older men with FUTI.
- To identify factors associated with MDRO infections in males with FUTI.
Main Methods:
- Ambispective observational study of males with FUTI in an Emergency Department.
- Data collected included age, comorbidities, healthcare-associated (HCA)-FUTI status, clinical symptoms, hospitalization, mortality, and microbiological profiles.
- Multivariate analysis was used to identify risk factors for MDRO FUTI.
Main Results:
- Older males (n=329) had higher rates of HCA-FUTI, increased comorbidity scores, and more frequent prior antimicrobial treatment.
- Older patients exhibited different causative pathogens (less E. coli, more Enterobacter spp., P. aeruginosa) and higher resistance rates to common antibiotics.
- Inadequate empirical treatment, higher hospitalization rates, and increased in-hospital mortality were observed in older males.
- Factors associated with MDRO FUTI included admission from long-term care, urinary tract abnormalities, and previous antimicrobial treatment.
Conclusions:
- Older men with FUTI present with distinct clinical and microbiological characteristics, including specific resistance patterns.
- While older age itself was not a direct risk factor for MDRO FUTI in multivariate analysis, specific comorbidities and prior treatments were significant.
- These findings highlight the need for tailored approaches to FUTI management in older male populations, considering their unique risk factors and resistance profiles.
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