Age, catheter use, comorbidities identify need for inpatient UTI treatment in women

28 Jul 2016

Older age, use of indwelling catheter, and presence of comorbidities may be associated with an increased need for inpatient (IP) treatment with antibiotics and for fungal infections in an Asian cohort of pre-menopausal women with urinary tract infection (UTI), according to a study presented at the 14th Urological Association of Asia (UAA) Congress 2016 held in Singapore.

These women who require IP treatment are also more likely to have diabetes mellitus (DM) or malignancies, researchers noted, adding that they represent a different group than those treated on an outpatient (OP) basis.

To profile the epidemiology and bacteriology of pre-menopausal female UTI in the IP versus the OP setting, the researchers analysed medical records of 433 patients (mean age 35.2 years) with a positive urine culture result and who presented for IP (n=240) or OP (n=193) treatment.

Patients in the IP group were older than those in the OP group (mean age 36.1 vs 34.2; p=0.027). UTI symptoms such as fever and acute urinary impairment were more prevalent in the IP than in the OP group (89.2 vs 10.8 percent; p<0.001 and 76.8 vs 23.2 percent; p=0.001, respectively), whereas lower urinary tract symptom was less prevalent in the IP group (41.6 vs 58.4 percent; p<0.001).

In terms of comorbidities, there were marked differences between the IP and the OP group for catheterisation (72.6 vs 27.4 percent, respectively; p=0.006), DM (69 vs 31 percent; p=0.005), and cancer (80.7 vs 19.4 percent; p=0.004).

Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis were the most common uropathogens identified in both groups. However, the proportion of patients with Candida albicans and Pseudomonas aeruginosa infections was substantially higher in the IP than the OP group (90.9 vs 9.1 percent; and 100 vs 0 percent, respectively).

The risk of UTI increases with age in women, with evidence showing menopause to be an important risk factor. A reduction in oestrogen secretion by the ovary results in decreased vaginal pH, preventing proliferation of Lactobacillus in the vaginal epithelium. [Int J Gen Med 2011;4:333–343]

DM may also promote UTI as mediated by dysfunctional voiding and urinary retention as induced by neuropathy involving the urinary tract.

Likewise, catheterisation is an important UTI-related issue in women. The tubes are a primary source of infection, with their hydrophilicity being associated with bacteria adhesion. Women are recommended to avoid latex catheters whenever possible. 

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