Urinary tract infection in the elderly

Abstract

Urinary tract infection is  the most common location of infectious pathology in the elderly. It can occur as a recurrent infection, which  means three or more symptomatic episodes per year, or more than two infections in 6 months. It could appear as an uncomplicated or complicated disease. The last one usually appears in people with functional  or structural abnormalities and mainly affects the upper urinary tract. In the elderly there is a high prevalence of urinary symptoms (incontinence, urgency, frequency, nocturia), but those symptoms are not always related to an infection. For this reason, the physiological changes associated with aging must be distinguished from pathological alterations. To achieve an adequate diagnosis, it is mandatory to do a detailed interrogatory, which includes information provided by the patient and the caregiver, a physical examination and  laboratory tests as needed, only if clinical symptoms are found, since the tests by themselves are not capable of differentiating asymptomatic bacteriuria from a urinary tract infection. Asymptomatic bacteriuria should not be screened or treated in the elderly. It is important to highlight that if treatment is indicated, it should be prescribed with caution, since providing unnecessary therapies causes microbial resistance, without achieving any survival benefit.