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Antibiotic treatment and resistance of unselected uropathogens in elderly women.
Nys, S., Koeijers, J., Bartelds, A., Donker, G., Stobberingh, E. Antibiotic treatment and resistance of unselected uropathogens in elderly women. Occhio Clinico: 2006(suppl. 6) 232. Abstract. 12th Regional Conference of the European Society of General Practice/Family Medicine: "Towards medical renaissance bridging the gap between biology and humanities", Florence, Italy on 27-30 August 2006.
Urinary tract infections (UTIs) are arnong the most common infections in wornen and the prevalence increases substantially with increasing age, i.e. from 5-10% for those until the age of 70 years to approximately 20% for those 80 years and older. Also, recurrent UTIs are more prevalent among postmenopausal than among younger women, and these infections are uncomfortable, costly and affect negatively the quality of life. A population-based study was conducted among women over the age 70 years attending 21 general practitioners (GPs) from the Sentinel Stations of the Netherlands Institute of Health Services Research (NIVEL) with symptoms of a UTI. In this study the usual GP care, i.e. the nitrite and leukocyte-esterase test (if performed) and therapy prescribed, was evaluated. Furthermore, the antibiotic susceptibility of the most prevalent uropathogens was determined. The positive predictive value of the nitrite test alone or in cornbination with the leukocyte-esterase test ranged between 83%-99%. Nitrofurantoin prescription rate decreased whereas fluoroquinolones and co-amoxiclav prescriptions increased with increasing age. The aetiology of infection was age depending. Escherichia coli (61%) was the uropathogen mostly isolated followed by Proteus rnirabilis (8%) and Klebsiella pneumoniae (6%). For these uropathogens the lowest susceptibility percentages were found for arnoxicillin (69-86%, K. pneumoniae excepted for), trimethoprim (73-86%) and co-trimoxazole (77-86%). Diagnosticte tests were reliable for the confirmation of UTIs in elderly wornen as well. As trimethoprim susceptibility reached -75%, it might be advisable not to use this agent as first choice in the treatment of uncomplicated UTIs in elderly wornen in The Netherlands. (aut.ref.)
Urinary tract infections (UTIs) are arnong the most common infections in wornen and the prevalence increases substantially with increasing age, i.e. from 5-10% for those until the age of 70 years to approximately 20% for those 80 years and older. Also, recurrent UTIs are more prevalent among postmenopausal than among younger women, and these infections are uncomfortable, costly and affect negatively the quality of life. A population-based study was conducted among women over the age 70 years attending 21 general practitioners (GPs) from the Sentinel Stations of the Netherlands Institute of Health Services Research (NIVEL) with symptoms of a UTI. In this study the usual GP care, i.e. the nitrite and leukocyte-esterase test (if performed) and therapy prescribed, was evaluated. Furthermore, the antibiotic susceptibility of the most prevalent uropathogens was determined. The positive predictive value of the nitrite test alone or in cornbination with the leukocyte-esterase test ranged between 83%-99%. Nitrofurantoin prescription rate decreased whereas fluoroquinolones and co-amoxiclav prescriptions increased with increasing age. The aetiology of infection was age depending. Escherichia coli (61%) was the uropathogen mostly isolated followed by Proteus rnirabilis (8%) and Klebsiella pneumoniae (6%). For these uropathogens the lowest susceptibility percentages were found for arnoxicillin (69-86%, K. pneumoniae excepted for), trimethoprim (73-86%) and co-trimoxazole (77-86%). Diagnosticte tests were reliable for the confirmation of UTIs in elderly wornen as well. As trimethoprim susceptibility reached -75%, it might be advisable not to use this agent as first choice in the treatment of uncomplicated UTIs in elderly wornen in The Netherlands. (aut.ref.)