Abstract

Introduction

Urinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population.

Methods

Pubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed.

Results

64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI.

Conclusion

UTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population.

中文翻译：

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尿路感染的治疗又老又脆弱。

摘要

介绍

尿路感染（UTI）在脆弱的老年人群中非常普遍。这篇综述旨在概述脆弱衰老人群中UTI的诊断，治疗和预防。

方法

进行了Pubmed和Web of Science搜索，以识别直至2019年3月的有关老年人口UTI管理的出版物。对现有文献进行叙述性回顾。

结果

64篇出版物被认为具有相关性，并被纳入本次审查。对老年人和脆弱的有症状的UTI的诊断可能具有挑战性。体弱的老年患者不建议常规筛查和无症状菌尿的抗菌治疗。谨慎选择抗生素应遵循通过培养和敏感性确定的尿路致病菌。了解局部抗生素耐药率在选择适当的抗菌治疗中起着基础性作用。在决定老年人症状性UTI的抗生素选择时，应考虑相关不良反应的影响，特别是那些对认知功能有影响的不良影响。对合并症（例如糖尿病）的最佳管理，对尿失禁的适当治疗，

结论

尿路感染是老年人群中一个重要但普遍的问题。照顾年老体弱的患者的医师必须意识到无症状泌尿道感染的治疗挑战，确定该人群中有症状的泌尿道感染及其适当的治疗策略。在研究中迫切需要评估非抗生素疗法对脆弱的老年人群预防UTI的作用。