title: [Community acquired urinary tract infections in older adults].
abstract: Background Community acquired urinary tract infections (caUTI) in adults are common ailments. Older adults are prone to infectious diseases, diagnosis can be difficult, their etiologic and antimicrobial resistance are poorly known. Objectives To evaluate the incidence discriminated by sex, symptoms, and to determine pathogens and their antimicrobial resistance rate. Methods A retrospective, descriptive and comparative study. We analyze uricultures among 2013 in the Hospital Nacional de Clinicas (Córdoba-Argentina). Patients over 65 years old, admitted with a caUTI diagnose were included; we exclude those with urinary catheter. Variables used: Sex, symptoms, pathogen isolation, antimicrobial resistance. For symptom variable was performed a comparative test. Descriptive statistics were used to analyze remaining variables. Results Were analyzed 349 patients: 1) Positive uricultures 191 (case), negative 158 (control). 2) Average age 77 (76% women, 24% men). 3) Symptoms: fever (45%), sepsis criteria (17%), altered mental status (14%), heart failure (11%). 4) Uriculture: monomicrobial 95.29%. 5) Isolation and resistance rate: Escherichia coli (67,7%): ampicillin/sulbactam 52.7%, ciprofloxacin 51.9%, trimethoprim/sulfamethoxazole 45.7%, cefotaxime: 12,9 %, amikacin: 3,9 %, Klebsiella pneumoniae (11,97%): ciprofloxacin 60.8%, trimethoprim/ sulfamethoxazole 50%, cefotaxime 47.8%, amikacin 4.7%. Enterococcus spp. (9,89%): ampicillin 0%, vancomycin 0%. Also isolated: Cándida spp. (3.66%), Proteus mirabilis (2,6%), Staphylococcus aureus (2,6%), Enterobacter cloacae (1,56%), Pseudomonas aeruginosa (1,56%). There were no imipenem resistances among gram negatives. Conclusions Isolations were mostly monomicrobial and at female gender. E. coli was the main uropathogen. The elevated resistance rate to ciprofloxacin, ampicillin/sulbactam and trimethoprim/sulfamethoxazole is remarkable. We suggest to avoid their empiric use in this population.
authors.affiliation: Doctor en Medicina y Cirugía. Especialista en Infectología. Especialista en Microbiología Clínica. Profesor Titular de la II Cá- tedra de Infectología de la Facultad de Ciencias Médicas de la Universidad Nacional de Córdoba. Jefe del Servicio de Infectología del Hospital Nacional de Clínicas.
authors.forename: Alberto Francisco
authors.initials: AF
authors.lastname: Leoni
authors.affiliation: . Bioquímica especialista en Bacteriología. Jefa del Departamento de Bacteriología. Laboratorio Central. Hospital Nacional de Clínicas.
authors.forename: Aida
authors.initials: A
authors.lastname: Monterisi
authors.affiliation: Especialista en Infectología. Ex concurrente del Hospital Nacional de Clínicas.
authors.forename: Paula G
authors.initials: PG
authors.lastname: Acuña
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001118:Argentina / Q000453:epidemiology; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents