Hospital Universitário Gaffrèe e Guinle, Department of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2012 Sep-Oct;16(5):436-41. doi: 10.1016/j.bjid.2012.06.025. Epub 2012 Sep 10.
Urinary tract infections (UTIs) in elderly patients can be a complex problem in terms of approach to diagnosis, treatment, and prevention, because the patients often present nonspecific symptoms. The epidemiological and clinical characteristics of UTI in elderly women were studied, in order to make early diagnosis and prevent serious clinical complications secondary to UTI.
This was a prospective population-based study, with elderly women, during their first medical office visit. Medical records were obtained by clinical history and physical examination in order to detect signs and symptoms of UTI and the presence of co-morbidities. Clean-catch midstream urine specimens for urinary dipstick test, sediment, and culture were collected; cervical samples for conventional Pap smears were also collected.
UTI was found in 16.55% of elderly women. The most frequent urinary symptom was foul smelling urine, in 60.6%. E. coli was responsible for 98 (76.56%) cases of significant bacteriuria; 34 (34.69%) were resistant to trimethoprim-sulfamethoxazole, and 21 (21.42%) to fluoroquinolones. Asymptomatic bacteriuria (AB) was not treated. The presence of predisposing factors demonstrated that the history of previous UTI (p < 0.001), vaginitis (p < 0.001), and diabetes (p = 0.042) increased the risk for UTI.
This study confirmed the high prevalence of UTI among elderly women and its unusual clinical presentation. Diabetes, history of previous UTI, and vaginitis were shown to be predisposing factors for UTI; it is not necessary to treat AB in elderly women, even among diabetics.
老年患者的尿路感染（UTI）在诊断、治疗和预防方面可能是一个复杂的问题，因为患者常表现出非特异性症状。本研究旨在探讨老年女性 UTI 的流行病学和临床特征，以便早期诊断并预防 UTI 引起的严重临床并发症。
这是一项前瞻性基于人群的研究，纳入首次就诊的老年女性患者。通过临床病史和体格检查获取病历，以发现 UTI 的体征和症状以及共存疾病。采集清洁中段尿用于尿干化学检测、沉渣和培养；还采集宫颈样本用于常规巴氏涂片。
16.55%的老年女性患有 UTI。最常见的尿路症状是尿液有异味，占 60.6%。大肠埃希菌导致 98 例（76.56%）有意义的菌尿症；34 例（34.69%）对复方磺胺甲噁唑耐药，21 例（21.42%）对氟喹诺酮类耐药。无症状菌尿症未予治疗。易患因素的存在表明，既往 UTI 史（p<0.001）、阴道炎（p<0.001）和糖尿病（p=0.042）增加了 UTI 的风险。
本研究证实老年女性 UTI 的患病率较高，且临床表现不典型。糖尿病、既往 UTI 史和阴道炎是 UTI 的易患因素；对于老年女性，即使是糖尿病患者，无症状菌尿症也无需治疗。
