The burden of comorbidity is associated with symptomatic polymicrobial urinary tract infection among institutionalized elderly.
BACKGROUND
Urinary tract infections (UTIs), often sustained by polymicrobial flora (p-UTIs), are a common finding among nursing home patients, and associated with adverse outcomes and increased healthcare costs. P-UTIs have been extensively studied with regard to microbiological aspects. However, little is known about the characteristics of the host.


OBJECTIVE
The aim of this study is to verify to which extent comorbidity characterizes elderly nursing home patients with p-UTIs.


METHODS
We enrolled 299 patients with culture-positive UTI consecutively admitted to the nursing home of the "Fondazione San Raffaele Cittadella della Carità", Taranto, Italy. P-UTI was diagnosed when two uropathogens were simultaneously isolated. The burden of comorbidity was quantified using the Charlson comorbidity score index. Logistic regression analysis was used to assess the adjusted association of the variables of interest with the presence of p-UTI.


RESULTS
P-UTIs were detected in 118/299 (39%) patients. According to logistic regression, the presence of p-UTIs was independently associated with the Charlson index (OR 1.70; 95% CI 1.06-2.72; P = .026). This association remained also after excluding participants without urinary catheter (OR 1.88; 95% CI 1.13-3.11; P = .015).


CONCLUSIONS
The presence of P-UTIs is associated with the burden of comorbidity, but not with individual diseases.


CONCLUSIONS
Older nursing home patients with comorbidity should be screened for the presence of p-UTIs; further studies are needed to evaluate the impact of early detection and treatment of p-UTIs on the development of comorbidity.
Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy. lavoralice@gmail.com.
Alice
A
Laudisio
Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy.
Felice
F
Marinosci
Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
Davide
D
Fontana
UOS Accesso e Presa in Carico Assistenziale, Azienda Sanitaria Locale Roma E, Borgo S. Spirito, 3, Rome, Italy.
Antonella
A
Gemma
Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy.
Alessandro
A
Zizzo
Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy.
Anna
A
Coppola
Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy.
Leonardo
L
Rodano
Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy.|Fondazione San Raffaele-Cittadella della Carità, Piazzale Mons. G. Motolese, 1, 74123, Taranto, Italy.
Raffaele
R
Antonelli Incalzi
D000368:Aged; D000369:Aged, 80 and over; D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology
Comorbidity; Elderly; Epidemiology; Nursing home; Urinary infection