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Asymptomatic bacteriuria in the elderly: High prevalence and high turnover of strains
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
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2008 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 40, no 10, 804-810 p.Article in journal (Refereed) Published
Abstract [en]

Asymptomatic bacteriuria (ASB) was followed in repeated prevalence surveys in a cohort of non-institutionalized residents (n=330), aged80 y. Urine samples were collected at baseline, and at 6, and at 18 months. Phenotyping (PhenePlate) was performed on isolates of Escherichia coli to evaluate strain relatedness. ASB occurred in 19.0, 19.4, and 19.9% in women, and in 9.4, 9.6 and 7.9% in men, at baseline and at the 6- and 18-months follow-up, respectively, and ASB was found at least once in 37% of women and in 20% of men. Of those with ASB at baseline, 60% also had ASB in the 2 subsequent surveys. Among those with persisting E. coli bacteriuria, 76% and 40%, respectively, carried the same strain at the 6- and 18-months follow-ups. In women, we found that the risk of developing a symptomatic urinary tract infection within 24 months was higher among those with ASB at baseline than in those without bacteriuria (p=0.019). ASB is common and often persistent, but we found a high turnover of strains, indicating a high rate of recolonization.

Place, publisher, year, edition, pages
2008. Vol. 40, no 10, 804-810 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97549DOI: 10.1080/00365540802195242ISI: 000259239700006OAI: oai:DiVA.org:uu-97549DiVA: diva2:172539
Available from: 2008-10-02 Created: 2008-10-02 Last updated: 2010-04-28Bibliographically approved
In thesis
1. Asymptomatic Bacteriuria in the Elderly
Open this publication in new window or tab >>Asymptomatic Bacteriuria in the Elderly
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore the features of asymptomatic bacteriuria (ASB) in elderly people living in the community, and to seek diagnostic tools to discriminate between ASB and symptomatic urinary tract infection (UTI).

All men and women aged 80 and over living in an urban district of Falun, Sweden, were invited to participate. Urine samples were obtained together with information on symptoms and on health indicators. The same cohort was surveyed again after 6 and 18 months. Urinary cytokines were analysed in 16 patients with UTI, in 24 subjects with ASB and in 20 negative controls.

ASB occurred at baseline in 19.0% of women and 9.4% of men, and was found at least once in 36.9% of women and in 20.2% of men. ASB in women was associated with reduced mobility and urge urinary incontinence. Of those with ASB at baseline, 60% still had bacteriuria at 6 and 18 months, but among those with repeated findings of ASB with E. coli, only 40% had the same bacterial strain after 18 months. In women, the risk of developing a UTI within 24 months was higher among those with ASB at baseline than in those without. Urinary levels of cytokines (CXCL1, CXCL8 and IL-6) and leukocyte esterase were higher in patients with UTI than in patients with ASB.

There is convincing evidence that ASB is harmless and should not be treated with antibiotics. However, such treatment is still often given, thereby unnecessarily contributing to the increased number of bacteria resistant to common antibiotics. This study confirms the high prevalence of ASB in elderly people living in the community. In order not to be misled by a urinary test showing bacteria, it is important to restrict urinary testing for bacteria to patients where there is a suspicion of UTI. In elderly patients with diffuse symptoms or in patients who are unable to communicate their symptoms, further diagnostic help could possibly be obtained by evaluating the urinary levels of leukocyte esterase and/or IL-6.

Place, publisher, year, edition, pages
Uppsala: Universitetsbiblioteket, 2008. 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 377
Keyword
family practice, aged 80 and over, E. coli, bacteriuria, urinary tract infections, urinary incontinence, leukocyte esterase, cytokines
National Category
Family Medicine
Identifiers
urn:nbn:se:uu:diva-9288 (URN)978-91-554-7285-6 (ISBN)
Public defence
2008-10-25, Föreläsningssalen, Falu lasarett, Falun, 13:15 (English)
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Supervisors
Available from: 2008-10-02 Created: 2008-10-02 Last updated: 2011-05-13Bibliographically approved

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