European Journal of Cardiovascular Medicine

Urinary tract infections (UTIs) are among the most common infections in the elderly, representing a major public health concern due to the associated morbidity and potential complications¹. The elderly population, typically defined as individuals aged 65 years and older, is more vulnerable to UTIs due to a combination of physiological changes, comorbidities, and the increased use of medical interventions, such as indwelling catheters. UTIs in elderly patients can lead to significant adverse outcomes, including kidney damage, sepsis, hospitalization, and an increased risk of mortality, making early identification and effective management essential².

The prevalence of UTIs in the elderly is influenced by several risk factors, including gender, chronic diseases (such as diabetes mellitus), urinary incontinence, and previous urinary catheterization. In females, hormonal changes after menopause, such as reduced estrogen levels, contribute to changes in the vaginal and urinary tract flora, making them more susceptible to infections³. For males, benign prostatic hyperplasia (BPH) and other urological conditions can obstruct the urinary flow, increasing the likelihood of infections⁴. The presence of diabetes mellitus is also a well-established risk factor for UTIs, as hyperglycemia can promote bacterial growth, impair immune response, and increase the likelihood of developing infections⁵.

The microbiological spectrum of UTIs in the elderly often includes Gram-negative bacteria, with Escherichia coli being the most commonly isolated pathogen. Other microorganisms, such as Klebsiella pneumoniae and Enterococcus faecalis, are also frequently identified. Antibiotic resistance is an emerging concern, particularly among these common pathogens, complicating the treatment and management of UTIs⁶. Resistance to commonly used antibiotics, such as fluoroquinolones and cephalosporins, can lead to prolonged infections, higher treatment costs, and a greater burden on healthcare systems⁷.

Despite the high prevalence of UTIs in the elderly, comprehensive data on the prevalence, associated risk factors, microbial profiles, and antibiotic resistance patterns in this population are limited. This study aims to fill this gap by assessing the prevalence of UTIs in elderly patients, identifying the risk factors that contribute to their occurrence, examining the microbial isolates, and analyzing the antibiotic resistance patterns in a cohort of elderly individuals.

Study Design and Setting: This was a cross-sectional study conducted at the Government Medical College and General Hospital, Ananthapuramu, over a period of three months, from April 2024 to June 2024. The study aimed to assess the prevalence, risk factors, microbial isolates, and antibiotic resistance patterns of urinary tract infections (UTIs) among elderly patients.

Study Population: The study included 100 elderly patients aged 60 years and above who were admitted to the hospital or visited the outpatient department with symptoms indicative of UTIs. Participants were selected based on inclusion and exclusion criteria outlined below.

Inclusion Criteria:

Elderly patients aged 60 years and above.

Patients presenting with symptoms of UTI such as dysuria, frequency, urgency, hematuria, fever, and flank pain.

Patients who consented to participate in the study.

Exclusion Criteria:

Patients with chronic kidney disease, urological malignancies, or other conditions that could complicate UTI diagnosis.

Patients with incomplete clinical data.

Patients on ongoing antibiotics at the time of admission.

Data Collection:

Demographic Data:

A structured questionnaire was used to collect demographic data, including age, gender, medical history (e.g., diabetes mellitus, hypertension), and history of risk factors such as urinary incontinence, catheterization, and immunocompromised conditions.

Clinical Examination and UTI Diagnosis:

All patients underwent a detailed clinical examination. A diagnosis of UTI was confirmed based on clinical symptoms, urine analysis, and culture results.

Urine Collection:

Mid-stream urine samples were collected from each participant in sterile containers to minimize contamination. The urine samples were then transported to the microbiology laboratory within one hour of collection.

Microbial Isolation and Identification:

Urine samples were cultured on standard media (e.g., MacConkey agar and blood agar). The plates were incubated at 37°C for 24-48 hours. Bacterial identification was carried out using standard biochemical tests (e.g., catalase, oxidase, urease) and automated systems, where applicable.

The most common microbial pathogens, including Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, were identified and isolated.

Antibiotic Sensitivity Testing:

The antibiotic resistance patterns of isolated pathogens were determined using the Kirby-Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The antibiotics tested included commonly used agents for UTIs, such as amoxicillin, ciprofloxacin, nitrofurantoin, and others.

The zones of inhibition were measured, and resistance was defined according to the CLSI guidelines.

Risk Factor Analysis:

A detailed review of patient medical histories was performed to identify potential risk factors for UTI. These included demographic factors (age, gender), comorbidities (diabetes, hypertension), urinary incontinence, catheterization history, and immunocompromised status. The association between these risk factors and the prevalence of UTIs was assessed using chi-square tests.

Statistical Analysis:

The data was analyzed using descriptive statistics to calculate frequencies, percentages, means, and standard deviations.

Chi-square tests were employed to assess the statistical significance of associations between categorical variables (e.g., gender, diabetes, urinary incontinence) and the prevalence of UTIs. A p-value of less than 0.05 was considered statistically significant.

Data were analyzed using SPSS version 22.0 (IBM Corporation, USA).

Ethical Considerations:

Ethical approval for the study was obtained from the Institutional Review Board (IRB) of Government Medical College and General Hospital, Ananthapuramu.

Informed consent was obtained from all participants, and confidentiality of patient data was maintained throughout the study.

In this study, we analyzed the demographic characteristics, prevalence of urinary tract infections (UTIs), risk factors, microbial isolates, and antibiotic resistance patterns in 100 participants. The mean age of the participants was 72.4 years (SD = 6.8). Of the 100 participants, 52 (52%) were female, and 48 (48%) were male (Table 1).

Table 1: Demographic Data

UTI Prevalence

The overall prevalence of UTI among the study population was 24%. Of the 24 UTI cases, 16 were female (66.7%) and 8 were male (33.3%) (Table 2).

Table 2: UTI Prevalence

UTI Age Distribution

The distribution of UTI cases across age groups revealed that the highest percentage of cases occurred in individuals aged 70-79 years (45.8%), followed by those aged 80+ years (33.3%). The least affected age group was 60-69 years, with 20.8% of cases (Table 3).

Table 3: UTI Age Distribution

Risk Factors for UTI

Several risk factors were significantly associated with UTI development. Female gender was found to be a risk factor, with 66.7% of UTI cases occurring in females, compared to 33.3% in the non-UTI group (p = 0.05). A history of diabetes mellitus was more common in the UTI group (50%) compared to the non-UTI group (22.5%), with a statistically significant p-value of 0.02. Urinary incontinence was also significantly associated with UTI, affecting 41.7% of UTI patients compared to 22.5% in the non-UTI group (p = 0.04). Catheterization was another significant risk factor, with 25% of UTI patients having a history of catheterization, compared to only 5% in the non-UTI group (p = 0.01). Additionally, immunocompromised status was found in 29.2% of UTI patients, significantly higher than the 6.3% in the non-UTI group (p = 0.03) (Table 4).

Table 4: Risk Factors for UTI

Microbial Isolates

The most common microbial pathogen isolated from UTI cases was Escherichia coli, which was found in 58.3% of cases. Other common pathogens included Klebsiella pneumoniae (20.8%), Enterococcus faecalis (12.5%), and various other pathogens (8.4%) (Table 5).

Table 5: Microbial Isolates

Antibiotic Resistance

Antibiotic resistance among the isolated bacterial strains was notably high. Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis all exhibited a resistance rate of 42.9% to the tested antibiotics (Table 6).

Table 6: Antibiotic Resistance

Urinary tract infections (UTIs) are among the most common infections in elderly individuals, posing significant health risks due to their potential for complications such as kidney damage, bacteremia, and increased morbidity and mortality. This study aimed to explore the prevalence, associated risk factors, microbial isolates, and antibiotic resistance patterns of UTIs in elderly patients, providing insights into the challenges faced by healthcare providers in managing these infections in this vulnerable population.

Prevalence of UTIs: The study revealed an overall UTI prevalence of 24% among the elderly population, which is consistent with other studies reporting varying prevalence rates in similar age groups. A higher prevalence of UTIs in elderly individuals is expected due to physiological changes associated with aging, including reduced immune function, altered renal function, and increased comorbidities. The study's finding that female patients exhibited a higher prevalence (66.7%) than male patients (33.3%) aligns with the well-established higher risk of UTIs in women, especially in the elderly. Anatomical factors such as a shorter urethra and postmenopausal changes in urinary tract physiology contribute to this higher incidence in females⁸.

Age-Related Trends: The highest prevalence of UTIs was observed in the age group 70-79 years (45.8%), which corroborates with existing literature showing that the incidence of UTIs increases with age, particularly in individuals over 70 years. Age-related changes, such as urinary retention, incontinence, and the increased likelihood of underlying medical conditions like diabetes and neurogenic bladder, contribute to the increased susceptibility to UTIs in this age group⁹.

Risk Factors: The study identified several significant risk factors for UTIs in the elderly population, including female gender, diabetes mellitus, urinary incontinence, a history of catheterization, and immunocompromised status. Female gender is a well-documented risk factor due to anatomical and hormonal changes in the urinary tract that predispose women to UTIs. The association between diabetes mellitus and UTIs in elderly patients is supported by the fact that hyperglycemia can impair immune responses, making diabetic patients more susceptible to infections. Additionally, urinary incontinence and catheterization were strongly linked to UTI risk, as these conditions facilitate the entry of pathogens into the urinary tract, particularly in institutionalized or bedridden elderly individuals¹⁰. The immunocompromised status, whether due to underlying diseases or medications, was also found to be a significant risk factor, as compromised immunity hinders the body’s ability to fight infections effectively.

Microbial Isolates and Antibiotic Resistance: The most common microbial pathogen identified in this study was Escherichia coli (58.3%), followed by Klebsiella pneumoniae (20.8%) and Enterococcus faecalis (12.5%). This is consistent with previous research, which has consistently shown that E. coli is the leading cause of UTIs in both community and healthcare settings¹¹. The high prevalence of these pathogens highlights the importance of targeted antimicrobial therapy to effectively manage UTIs in elderly patients.

Antibiotic resistance among common UTI pathogens was notably high, with E. coli, Klebsiella pneumoniae, and Enterococcus faecalis exhibiting a resistance rate of 42.9% to the tested antibiotics¹². This is a concerning finding, as antibiotic resistance can lead to treatment failures, prolonged hospital stays, and the need for more expensive and potentially more toxic alternative antibiotics. The emergence of resistant pathogens is particularly problematic in elderly patients, who may have multiple comorbidities and a weakened immune system, making them more vulnerable to severe outcomes from infections¹³. The high resistance rates underscore the importance of prudent antibiotic use, as well as the need for regular surveillance of resistance patterns to guide empiric treatment and reduce the emergence of resistance¹⁴.

Implications for Management and Prevention: The findings of this study have important implications for the management of UTIs in elderly patients. First, the identification of key risk factors emphasizes the need for targeted prevention strategies, such as improving management of diabetes, addressing incontinence, minimizing unnecessary catheter use, and enhancing immune function through vaccination or other means. Healthcare providers should also consider the high prevalence of antibiotic resistance when prescribing treatment, ensuring that empirical antibiotic therapy is based on local resistance patterns and susceptibility testing.

Furthermore, this study highlights the importance of infection control measures, especially in healthcare settings where elderly patients may be exposed to catheterization or other invasive procedures. Regular monitoring and the judicious use of antibiotics are critical to preventing the development and spread of resistant organisms.

Study Limitations: While the study provides valuable insights into the prevalence and risk factors of UTIs in elderly patients, there are some limitations. The cross-sectional design limits the ability to establish causality between risk factors and UTI occurrence. Additionally, the study was conducted at a single hospital, which may limit the generalizability of the findings to other settings or populations. Future longitudinal studies are needed to explore the long-term risk factors and outcomes of UTIs in elderly patients. Furthermore, the study did not explore the role of other potential risk factors, such as cognitive impairment, which could influence UTI incidence in the elderly.

UTIs remain prevalent in elderly patients, with several modifiable and non-modifiable risk factors contributing to their development. The study’s findings highlight the need for targeted prevention and management strategies, particularly in light of the high rates of antibiotic resistance among common UTI pathogens. Effective management of UTIs in the elderly population requires a multi-faceted approach, including better infection control practices, appropriate antibiotic use, and close attention to the unique risk factors associated with aging.

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