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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, April 3, 2014

Infección del tracto urinario (Parte 2)

By Christina Shenvi, MD PhD | April 2nd, 2014
"It seems like a simple enough question: How do you diagnose and treat uncomplicated urinary tract infections (UTIs) in older adults? The answer is: It depends. In Part 1 of this post we discussed the diagnosis of UTIs in cognitively intact older adults and those with underlying cognitive impairment. This post will discuss treatment options.
UTIs are the most common bacterial infection diagnosed in older adults (age 65 and over) [1]. They are the most common reason for antibiotic use [2] and account for 5% of ED visits in this population [2]. Remember from part 1 that asymptomatic bacteriuria is very common in older adults, and does not require treatment. Furthermore, pyuria with or without bacteriuria is also common in asymptomatic older adults, particularly those with chronic incontinence [3]. The key to distinguishing a UTI from asymptomatic bacteriuria (ASB) is the patient’s symptoms. Also remember, that in older adults a male patient with a UTI is considered complicated, as well as patients with pyelonephritis, sepsis, indwelling catheters, or recent instrumentation. As with anything in medicine, there are risks and benefits to treatment. The benefits include relieving symptoms, and preventing progression of the infection to pyelonephritis or baceteremia. However, overuse of antibiotics can breed resistant bacteria, and the medications we use (as will be detailed below) are not without side effects. If it is clearly a UTI, then give antibiotics. If it is clearly asymptomatic bacteriuria or pyuria, then don’t. If you are not sure, and the patient or their care-giver are reliable, you could consider a wait-and-see approach in which you give a prescription, and instruct them to fill it only if the patient develops symptoms. Or, if the patient has good follow up, you could have them rechecked after 2 days, once the urine culture is completed."