Urinary tract infection in women over the age of 65: is age alone a marker of complication?
BACKGROUND
We were interested to know if our older female patients with urinary tract infections (UTIs) might have differing pathogens or rates of Escherichia coli antibiotic sensitivity and if our physicians managed them in a manner similar or dissimilar to the care provided to younger patients with no complications.


METHODS
This was a secondary analysis from patients excluded from a previous retrospective study regarding uncomplicated UTIs.


RESULTS
Twenty-six percent of total patients with UTIs were older than 65 and otherwise medically uncomplicated whereas 21% were older patients who did have complicating factors. E. coli was a pathogen in 81% of uncomplicated elders' and 54% of complicated elders' cultures. E. coli sensitivity rate to sulfamethoxazole-trimethoprim (SMX/TMP) in both groups was 86%. Physicians were significantly less likely to prescribe SMX/TMP for complicated older patients with complications than for young patients with an uncomplicated UTI (P = .017); there was a significant trend of physicians to be less likely to prescribe SMX/TMP with advancing age in a patient and complications across all 3 groups (P = .011). Antibiotics rarely needed to be changed after cultures.


CONCLUSIONS
The presence of E. coli on culture in patients with a UTI changes based on medical complications, not age. Being medically complex did not result in reduced sensitivity of E. coli to SMX/TMP but was associated with increased rates of the presence of other pathogens. In our setting, treatment employed with SMX/TMP and without the use of culture and sensitivity may be effective for appropriately selected older women. Prospective studies are needed to determine the optimal approach to management.
Department of Family Medicine, Mayo Clinic College of Medicine, 13737 North 92nd Street, Scottsdale, AZ 85260, USA. grover.michael@mayo.edu
Michael L
ML
Grover
Jesse D
JD
Bracamonte
Anup K
AK
Kanodia
Frederick D
FD
Edwards
Amy L
AL
Weaver
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004363:Drug Utilization; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005194:Family Practice / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D015662:Trimethoprim, Sulfamethoxazole Drug Combination