Prevalence and prognostic influence of bacterial pyuria in elderly patients with pneumonia: A retrospective study.
OBJECTIVE
The number of elderly patients with pneumonia is significantly increasing as the populations in many countries age. Although elderly patients with pneumonia are at risk of developing urinary tract infections, no studies have examined the prevalence or the prognostic impact of this complication. The aim of the present study was to investigate the prevalence of comorbid bacterial pyuria and the impact on the prognosis of elderly patients with pneumonia.


METHODS
We retrospectively evaluated 132 patients aged >65 years who were hospitalized for pneumonia and who underwent a urinary sediment test on admission. The background characteristics, laboratory results and treatment regimens were documented, and the risk factors for the complication of bacterial pyuria and its association with 90-day mortality in pneumonia patients were elucidated.


RESULTS
A total of 37 (28%) of 132 patients were complicated by bacterial pyuria. The patients with bacterial pyuria were more often women, showed a poorer performance status, were more frequently fed by percutaneous endoscopic gastrostomy, and more frequently used diapers and/or a bladder catheter. Regarding first-line drugs, 82.6% of the patients received beta-lactamase inhibitors and extended-spectrum penicillins. The use of a bladder catheter and a poor performance status were associated with bacterial pyuria. A multivariate analysis showed that a poor performance status was the only factor associated with 90-day mortality.


CONCLUSIONS
Bacterial pyuria did not affect the prognosis of patients who were treated with penicillin-based regimens. Thus, broad-spectrum antibiotics are not necessarily required for elderly patients with pneumonia complicated by urinary tract infection. Geriatr Gerontol Int 2017; 17: 1076-1080.
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.|Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.|Respiratory Medicine, and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.
Hiroaki
H
Oka
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.|Clinical Research Center of Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.|Respiratory Medicine, and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.
Kosaku
K
Komiya
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.|Respiratory Medicine, and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.
Minoru
M
Ohama
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Yoshiyuki
Y
Kawano
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Masahiro
M
Uchida
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Hajime
H
Miyajima
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Tomohiko
T
Iwashita
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Eiji
E
Okabe
Neurosurgery, Tenshindo Hetsugi Hospital, Oita, Japan.
Tadao
T
Kawamura
Gastroenterological Surgery, Tenshindo Hetsugi Hospital, Oita, Japan.
Kazuhiro
K
Yasuda
Department of Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Taisuke
T
Matsumoto
Respiratory Medicine, and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.
Jun-Ichi
JI
Kadota
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011776:Pyuria / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
bacterial pyuria; bacteriuria; elderly patient; pneumonia; urinary tract infection