Characteristics of urinary tract infections in older patients in a tertiary hospital in Greece.

AIMS: Urinary tract infections (UTIs) are commonly encountered. They are more commonly caused by Enterobacteriaceae, while antimicrobial resistance is an emerging problem in their management, with extended-spectrum-β-lactamase (ESBL) producing Gram-negative bacteria and multidrug-resistant (MDR) Pseudomonas aeruginosa being increasingly common. The purpose of this study was to investigate the epidemiology and outcomes of UTIs in patients admitted in a tertiary hospital, which mostly admits geriatric patients, and compare the effects of antimicrobial resistance on patient outcomes.

METHODS

A retrospective observational study was conducted at a University Hospital in Crete, Greece. Epidemiology and clinical characteristics of patients with a UTI were recorded.

RESULTS

During the 3-year period of the study, 204 UTIs were recorded. Mean age was 83.3 years and 38.7% were male. The most common isolated pathogens were Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis. Among all patients with UTI, 15.7% had an infection from ESBL, MDR, extensively drug-resistant or vancomycin-resistant enterococci pathogens. Recent antimicrobial use or hospitalization, dementia, bedridden state and sex were independently associated with mortality, while being a nursing home resident was independently associated with a higher possibility of infection from ESBL, MDR, extensively drug-resistant or vancomycin-resistant enterococci pathogens. Infection by such a resistant pathogen led to increased duration of hospitalization but not to increased mortality.

CONCLUSIONS

Alarming antimicrobial resistance rates were noted in patients with UTIs, and this led to longer duration of hospitalization even though it did not have an impact on mortality, which was otherwise higher than in other studies. Geriatr Gerontol Int 2020; 20: 1228-1233.