Urinary tract infections in elderly patients.

Urinary tract infections (UTIs) in the elderly are common. The pathophysiology of increased susceptibility is multifactorial. Age-related changes include a decline in cell-mediated immunity, neurogenic bladder dysfunction, structural urinary tract abnormalities (e.g., benign prostatic hyperplasia), systemic diseases (e.g., diabetes mellitus) and increased incidence of urethral catheter placement. Catheter-associated bacteriuria is the most common hospital-acquired infection. Many elderly patients, including those with catheter-associated bacteriuria, are asymptomatic. Escherichia coli remains the most common uropathogen. However, polymicrobial infection is more common among the elderly. The use of antimicrobial agents needs to be guided by current surveillance studies of targeted uropathogenic bacteria before being implemented. However, UTIs in the elderly may lead to severe renal infections. Therefore surgical intervention may be needed in these infections.