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Urinary Tract Infections In The Elderly PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Urinary Tract Infections in the Elderly” by John Gotelli, NP.

This medical PowerPoint presentation is about Urinary tract infections (UTIs) in the elderly. UTIs are common in the elderly population, particularly in those over the age of 65. In fact, UTIs are one of the most common bacterial infections in older adults. There are several reasons why the elderly are more susceptible to UTIs, including changes in the immune system, changes in bladder function, and an increased likelihood of medical conditions that can increase the risk of infection.

Tags : Urinary tract infections, UTIs, bacterial infections in older adults, Geriatrics, Geriatric Medicine, Geriatrics PowerPoint presentation

Published on : May 02, 2023 | Views : 1357 | Downloads : 5

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Urinary Tract Infections in the Elderly John Gotelli, NP
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Objectives Differentiate between asymptomatic bacteruria and UTI Learn geriatric “pearls” in identifying, preventing and treating UTIs in elderly Review antibiotic treatment guidelines for UTIs in elderly Discuss techniques in preventing both complicated and uncomplicated UTIs in elderly Understand risks associated with use of Indwelling Urinary (foley) catheters
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Disclaimer This presentation is a synopsis of both Infectious Disease Society of America (IDSA) as well as the Centers for Disease Control (CDC) recommendations for the recognition and management of urinary tract infections. These are just two of a handful of guidelines from other academic or governing bodies. If your institution uses other guidelines, then please refer to those. Additionally, I may be unfamiliar with other published guidelines or your institutional guidelines.
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Definitions Urinary Tract Infection (UTI) aka Acute Uncomplicated Cystitis – infection of the bladder (lower urinary tract) Symptomatic UTI (SUTI)- occurs with manifestation of signs/symptoms of infection which localize to urinary tract. These same signs/symptoms in those with an indwelling urinary catheter are Catheter Associated UTI (CAUTI) – manifestation of signs symptoms of infection localized to urinary tract in those with indwelling catheter or removed within 2 days. Cather Asymptomatic Bacteriuria (CA-ASB) – Presence of > or = 10(5) cfu/ml of > or = 1 bacterial species in a catheter urine specimen in patient with an indwelling urethral or suprapubic catheter without symptoms Pyelonephritis – infection of the upper urinary tract (ureters / renal collecting system / kidneys). Asymptomatic Bacteriuria (ASB)– Isolation of a specific count of bacteria in a urine specimen from an individual w/o signs or symptoms of UTI
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Definitions, cont Can be localized to either lower or upper urinary tract Complicated UTI (cystitis) Diabetes Pregnancy H/O pyelonephritis Hospital acquired infection Urinary Tract Obstruction (men) Catheter (or recent catheterization in prior 48 hours) Childhood h/o UTIs Immunosupression Renal Transplant
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Introduction, cont Population 63% are 65 or > Current population in LTC is 6.3 million By 2050 total number of individuals needing paid LTC/Institutional LTC will double to around 27 million Infection / Illness often times presents differently in aged >> lack of fever / blunted white cell count / mental status changes / functional decline / anorexia / agitation
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UTI in LTC Primary cause of bacteremia in LTC residents is due to UTIs Incidence of symptomatic UTIs in elderly in LTC around 10% Prevalence of asymptomatic bacteriuria in women approx. 30% and 10% in men Why so common?
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UTI in LTC Risk Factors Physiologic changes of bladder / urethral flora w/ age (post/menopausal women) Use of indwelling catheters Congregate living Functional / Cognitive Impairment Decrease self care Decrease cues to void Difficulty finding bathroom / suitable location to void ?Elevated Post Void Residual Volume of Urine?
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UTI Surveillance Criteria(CDC 2010) Diagnostic Criteria for symptomatic UTI in those w/o indwelling catheter (1a OR 2a OR 3a) Criteria 1a Acute dysuria, pain, swelling/tenderness of prostate/testes Criteria 2a Fever or leukocytosis AND at least 1 of following CVA tenderness Suprapubic pain Hematuria Marked increase/new onset incontinence Criteria 3a Suprapubic pain Hematuria Marked increase/new onset incontinence AND At least 10(5) cfu/ml of no more than 2 species of bacteria in voided urine At least 10(2) cfu/ml of any number of organisms in a straight cath.
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Guidelines, cont In patients with Indwelling catheters Must demonstrate at least one of the following Fever/chills or new onset hypotension without evidence of other source of infection Acute change in mental status or functional decline AND leukocytosis without alternate site of infection New onset suprapubic pain or CVA pain Purulent discharge from catheter site OR acute pain/swelling/tenderness of tests/prostate. AND if catheter removed within last 2 calendar days At least 10(5) cfu/ml of no more than 2 organisms from voided urine OR positive culture of at least 10(2) of any organisms from straight catheterization IF catheter still in place then culture with at least 10(5) of any organisms from an indwelling catheter specimen.
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Treatment – with catheter Treatment Empiric Tx based on gram stain. Gram (-) bacilli - 3rd gen cephalospirin (ceftriaxone, cefpodoxime) OR cipro/levo. P. Aeruginosa may use cipro / ceftazadime. Gram (+) vancomycin pending susceptibility Usually 10 to 14 days of tx When to change foley catheter ? IDSA guidelines do not recommend routine exchange IF CA-UTI is suspected, then ideally remove catheter, obtain clean catch urine from newly exchanged catheter and base tx on that culture. Antimicrobial coated catheters can be considered for use.
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Approach to choosing an optimal antimicrobial agent for empirical treatment of acute uncomplicated cystitis. Kalpana Gupta et al. Clin Infect Dis. 2011;52:e103-e120 © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
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UTI in Men (complicated) Pathogens similar to women. Differential Dx >> prostatitis (acute or chronic), urethritis. Diagnosis and Treatment extrapolated from women >> Clinical – dysuria, frequency, urgency, suprapubic pain (same as prior slide) with following considerations (Up To Date 2016) Urine culture in men use count of > or equal to 10 (4) vs 10 (5) of single isolated CFU / ml. Isolated bacteria in men similar to women – E. coli (75 to 90%), Proteus mirabilis, Klebsiella pneumoniae Recurrent UTI in Men – further evaluation warranted (e.g. chronic prostatitis, consider urologic referral)
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Asymptomatic Bacteriuria (ASB) ASB in LTC Women 2 consecutive clean catch midstream urine samples of > _ 10 (5) cfu/ml w/o symptoms associated w/ UTI and no catheter within 7 days of first sample Men Single clean catch midstream of >_ 10 (5) cfu/ml w/o symptoms associated with UTI and no catheter Longer term sequela of bacteriuria not known Treatment not shown to reduce symptomatic UTI, improve mortality nor decrease in prevalence of bacteriuria (i.e. no indication for eradication therapy). Common – perhaps 55% of women in LTC and 30% of men
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Prevention and Other Issues Prevention of UTI in LTC Most studies have focused on younger / pre-menopausal women (McMurdo study age 45 to 92 – see below) General Hygiene Prompted / assisted voiding Bowel regimen
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Prophylaxis, cont. Cranberry juice/extract – currently not enough evidence to recommend for or against use. Cochrane guidelines found no strong evidence for recommending use in prophylaxis (2012). Prophylaxis against recurrent UTI (>_3 utis within 12 mos. OR >_2 within 6 mos). Studies have shown benefit of co-trimoxazole, nitrufurantoin, quinolones, b-lactams in reducing recurrent utis vs placebo. No guidelines. Reasonable approach is TMP-SX 40/200 tablet 3 days a week. Oral Estrogens not shown to be beneficial. Topical, vaginally applied estrogens have been shown to be effective in smaller studies (though sample was post-menopausal) Summary – Current mainstream guidelines (IDSA, Cochrane Reviews) state that there is insufficient evidence for use of cranberry juice/extract.
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Prevention and Other Issues Prevention of CA-UTI Identify those patients who meet clinical criteria for long / short term placement of indwelling Obstruction Neurogenic bladder Hematuria (short term) Surgery (short term) Wounds stage 3 or > Aggressive diuresis / monitoring of strict I/O (short term) Terminally ill for comfort measures Develop policies for independent removal and education on technique for placement and management of device and collecting bag
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References Cohen, KR; Frank, J; Israel, I (2011). UTIS in the geriatric population: chanllenges for clinicians. US Pharmacist. 36 (6) p. 46-54 Family CareGiver Alliance: National Center on Caregiving. (2012). Fact Sheet: Selected Long-Term Care Statistics. Fekete,T ; Calderwood, SB; Baron, E (2011) Urinary tract infection associated with urethral catheters. UpToDate. Accessed online January, 2012 Garner, JS; Jarvis, WR, Emori, TG, et al (1988) CDC Definitions of Nosocomial Infections. Journal of Infection Control, 16. p 128-140 Gupta, K; Hooton, TM; Naber, KG; Wult, B; Colgan, R; Miller, LG; Moran, GJ; Nicolle, LE; Raz, R; Schaeffer, AJ; Soper, DE (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the infectious disease society of america and the european society for microbiology and infectious disease. Clinical Practice Guidelines. 2011:52, March
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References Hooton, TM; Calderwood, SB; Baron, E (2011) Acute Uncomplicated cycstitis, pyelonephritis, and asymptomatic bacteriuria in men. UpToDate. Accessed online January, 2012 Hooton, TM; Bradley, SF; Cardenas, DD; Colgan, R; Geerlings, SE; Rice, JE; Saint, S; Schaeffer, AJ; Tambayh, PA; Nicolle, LE (2010) Diagnosis, prevention, and treatment of of catheter associated urinary tract infection in adults: 2009 international clinical practice guidelines from the infectious disease society of america. Clinical Practice Guidelines. 2010: 50 March Mathews, JS; Lancaster, JW (2011) Urinary tract infection in the elderly population. The American Journal of Geriatric Pharmacotherapy. 9 (5) p. 286-309 McMurdo, ME; Argo, I; Phillips, G; Daly, F; Davey P. (2009) Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. Journal of Antimicrobial Chemotherapy 63, p 389-395 Mouton, C; Adenuga, B; Vijayan, J (2010). Urinary tract infections in long-term care. Annals of Long-Term Care 18 (2) p. 35-39.