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Asymptomatic bacteriuria prevalence and its relationship with urinary tract infections in the elderly

Giriş: Ülkemizde 65 yaş üstü popülasyonda üriner sistem enfeksiyonu (ÜSİ) gelişmesinde önemli yeri olan asemptomatik bakteriüri (ASB) prevelansı iyi tanımlanmamıştır. Bu çalışmanın amacı İzmir, Türkiye’deki 65 yaş üzeri huzurevi popülasyonunda ASB prevelansı ile üriner sistem enfeksiyonu gelişmesi arasındaki bağlantının araştırılmasıdır.Metot: Bu çalışma İzmir’de üç büyük huzurevindeki 65 yaş üstü üriner sistem semptomu olmayan, son 15 gün içinde üriner kateterizasyon uygulanmamış ve herhangi bir nedenle son bir haftadır antibakteriyel tedavi almayanlar ve 2003 ile 2004 yılları arasında yapıldı. Hastalardan sabah ilk orta akım idrar örnekleri ve 24-48 saat sonra ikinci idrar örnekleri alındı. ASB tespit edilenler ve edilmeyenler altı ay klinik takibe alınarak aralıklarla üriner sistem enfeksiyonu gelişip gelişmediği kayıt edildi. Üçüncü ayda ise hastalarda ASB’nin devam edip etmediği araştırıldı. Hastalar aynı zamanda ASB’yi kolaylaştırıcı etkenler açısından da incelendi.Bulgular: Toplam 606 hastadan 146’sında ASB tespit edildi (% 24,1). ASB sıklığı kadınlarda erkeklere göre daha sık idi (% 27,8 vs. % 18,6; p=0,009). ASB görülme oranının yaş ve huzurevindeki kalış süresiyle arttığı sonucuna varıldı. Takipte hastaların hiçbirisinde üriner sistem enfeksiyonu ve ölüm gelişmedi. Üçüncü aydaki kontrollerde Proteus spp. dışındaki ASB etkenlerinin aynen devam ettiği görüldü.Sonuç: ASB prevelansı ülkemizde de yaşlılarda oldukça yüksektir. ASB ile üriner sistem enfeksiyonu arasında dolaylı veya doğrudan bir ilişki kurulamamıştır

Anahtar Kelimeler:

Asemptomatik bakteriüri, huzurevi, üriner sistem enfeksiyonu

Asymptomatic bacteriuria prevalence and its relationship with urinary tract infections in the elderly

Objective: The aim of this study was investigation of ASB prevalence and the relation for development of UTI in the people aged over 65 living in three nursing homes in Izmir province, Turkey. Methods: The people aged over 65 in three nursing homes in Izmir, who did not suffer from any urinary system symptoms, on whom no urinary catheterizations were applied within the last 15 days, and who had not received any antibacterial treatments for the last one week for any reason, were included in the study between 2003 and 2004. First urine specimens were collected in the morning and the second were collected 24 to 48 hours later. ASB were included in clinical follow-up for six months and whether or not any UTI developed was recorded at intervals. At the third month, however, it was investigated whether ASB continued in patients or not. Patients were also examined in terms of ASB facilitating factors at same time. Results: ASB was detected in 146 (24.1%) of 606 patients and more frequent in females than males (%27.8 vs. %18.6; p=0.009). The prevalence of ASB increased by age and length of stay in the nursing home. UTI was not developed and no death occurred in any of the patients during the follow-up period. At the third follow up month, it was observed that the ASB except Proteus spp. continued likewise. Conclusion: The ASB prevalence was found as quite high in elderly in our country. Direct or indirect relationship between ASB and UTI has not been established.

Keywords:

Asymptomatic bacteriuria, nursing homes, Urinary tract infections,

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Catherine DB, Bernstein JM. Urinary tract infections. Med Clin North Am 1997;81:719-730.
Matsumoto T. Urinary tract infections in the elderly. Curr Urol Rep 2001;2:330-333.
Shortliffe LM, McCue JD. Urinary tract infections at the age extremes: pediatrics and geriatrics, Am J Med 2002; 8 (suppl IA):55s-66s.
Hansson S, Martinell J. The natural history of bacteriuria in childhood. Infect Clin North Am 1997;11:499-512.
Yamamoto S, Tsukamoto T, Terai A, Kurazono H, Takeda Y, Yoshida O. Persistent bacteriuria caused by uropatojenic Escherichia coli. Urol Int 1996;57: 89-92.
Svanborg C, Godaly G. Bacterial virulence in urinary tract in- fection. Infect Clin North Am 1997;11:513-529.
Hooton TM, Stamm W. Diagnosis and treatment of uncom- plicated urinary tract infection. Infect Dis Clin North Am 1997;11:551-581.
Wullt B, Bergsten G, Samuelsson M, Svanborg C. Effect of P fimbriae on pyuria and bacterial colonization of the human urinary tract. Urologe A 2003;42:233-237.
Geerlings SE, Meiland R, van Lith EC, Brouwer EC, Gaastra W, Hoepelman AI. Adherence of type 1-fimbriated Escherich- ia coli to uroepithelial cells: more in diabetic women than in control subjects. Diabetes Care 2002;25:1405-1409.
Rahav G, Pinco E, Bachrach G, Bercovier H. Molecular epi- demiology of asymptomatic bacteriuria in the elderly. Age Ageing 2003;32:670-673.
Vranes J, Kruzić V, Sterk-Kuzmanović N, Schönwald S. Viru- lence characteristics of Escherichia coli strains causing as- ymptomatic bacteriuria. Infection 2003;31:216-220.
Semetkowska-Jurkiewicz E, Horoszek-Maziarz S, Galiński J, Manitius A, Krupa-Wojciechowska B. The clinical course of untreated asymptomatic bacteriuria in diabetic patients- 14-year follow-up. Mater Med Pol 1995;27:91-95.
Childs SJ, Egan RJ. Bacteriuria and urinary infections in the elderly. Urol Clin North Am 1996;23:43-54.
Nicolle LE. Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am 1997;11:647-62.
Nicolle LE. Bacteriuria and urinary tract infections in the el- derly. In: Mulholand SG, (eds). Antibiotic Thearpy in Urology. Philadelphia, JB Lippincott, 1995:34-41.
Nicolle LE. Asymptomatic bacteriuria: review and discus- sion of the IDSA guidelines. Int J Antimicrob Agents 2006;28 (Suppl 1):S42-S48.
Raz R. Postmenopausal women with recurrent UTI. Int J An- timicrob Agents 2001;17:269-271.
Kutsal YG. Yaşlılık ve fizyolojik değişimler. In: Kutsal YG, Çakmakçı M, Ünal S, eds. Nobel, Geriatri.1997:123-41. (In Turkish)
Nicolle LE. Urinary infections in the elderly: symptomatic of asymptomatic? Int J Antimicrob Agents 1999;11:265-268.
Orenstein R, Wong ES. Urinary tract infections in adults. Am Fam Physician 1999;59:1225-1234.
Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vi- tro antimicrobial resistance of urinary Escherichia coli iso- lates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother 2012; 56:2181-2183.
Rizvi M, Khan F, Shukla I, Malik A, Shaheen. Rising preva- lence of antimicrobial resistance in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians 2011;3 (2):98-103.
Ariathianto Y. Asymptomatic bacteriuria - prevalence in the elderly population. Aust Fam Physician 2011;40:805-809.