Skip to main content
Erschienen in: Zeitschrift für Gerontologie und Geriatrie 7/2015

01.10.2015 | Beiträge zum Themenschwerpunkt

Harnwegsinfekte im Alter

verfasst von: Dr. med. Klaus Friedrich Becher, MHBA, M.D., Dr. Ingo Klempien, M.D., Priv.-Doz. Dr. Andreas Wiedemann, M.D., PHD

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 7/2015

Einloggen, um Zugang zu erhalten

Zusammenfassung

Harnwegsinfekte sind eine der am häufigsten vorkommenden bakteriellen Infektionen. Bei gebrechlichen älteren Menschen sind sie verantwortlich für eine erhebliche Morbidität sowie rezidivierende Infektionen mit nachfolgenden Resistenzen gegen Antibiotika. Obwohl eine Therapie häufig entweder nicht notwendig erscheint oder durch eine kurze Antibiotikatherapie behandelt wird, kommt es immer wieder zu teils hochakuten Krankheitsverläufen und Reinfektionen. Die biologische Komplexität der Infektionsmechanismen und die dramatisch hohen Zahlen von antibiotikaresistenten Pathogenen, machen eine intelligente Therapiestrategie notwendig und stellen damit nicht nur eine klinische Herausforderung dar, sondern ermöglichen auch die rasche Heilung. Der erste entscheidende Schritt ist die genaue Klassifizierung des Harnweginfekts von der symptomfreien Bakteriurie bis zur komplizierten Pyelonephritis. Hier wird bereits über die Aggressivität der Behandlung sowie den diagnostischen Aufwand entschieden. Für die Entwicklung einer empirischen antimikrobiellen Therapie ist die Kenntnis der häufigsten Erreger sowie der lokalen Resistenzmuster wichtig. Bei gezieltem Vorgehen können die meisten Harnwegsinfekte auch beim geriatrischen Patienten ohne erhöhten diagnostischen Aufwand therapiert werden.
Literatur
1.
Zurück zum Zitat Albert X, Huertas I, Pereiro II et al (2004) Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev (3):CD001209 Albert X, Huertas I, Pereiro II et al (2004) Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev (3):CD001209
2.
Zurück zum Zitat Arinzon Z, Shabat S, Peisakh A, Berner Y (2011) Clinical presentation of urinary tract infection (UTI) differs with aging in women. Arch Gerontol Geriatr 55(1):145–147CrossRefPubMed Arinzon Z, Shabat S, Peisakh A, Berner Y (2011) Clinical presentation of urinary tract infection (UTI) differs with aging in women. Arch Gerontol Geriatr 55(1):145–147CrossRefPubMed
3.
Zurück zum Zitat Balogun SA, Philbrick JT (2013) Delirium, a symptom of UTI in the elderly: fact or fable? A systematic review. Can Geriatr J 17(1):22–26. doi:10.5770/cgj.17.90. (eCollection 2014)PubMedCentralPubMed Balogun SA, Philbrick JT (2013) Delirium, a symptom of UTI in the elderly: fact or fable? A systematic review. Can Geriatr J 17(1):22–26. doi:10.5770/cgj.17.90. (eCollection 2014)PubMedCentralPubMed
4.
Zurück zum Zitat Barkham TMS, Martin FC, Eykyn SJ (1996) Delay in the diagnosis of bacteraemic urinary tract infection in elderly patients. Age Ageing 25:130–132CrossRefPubMed Barkham TMS, Martin FC, Eykyn SJ (1996) Delay in the diagnosis of bacteraemic urinary tract infection in elderly patients. Age Ageing 25:130–132CrossRefPubMed
5.
Zurück zum Zitat Bodmann KF, Grabein B et al (2010) Empfehlungen zur kalkulierten paenteralen Initialtherapie bakterieller Erkrankungen. Chemother J 19:179–255 Bodmann KF, Grabein B et al (2010) Empfehlungen zur kalkulierten paenteralen Initialtherapie bakterieller Erkrankungen. Chemother J 19:179–255
6.
Zurück zum Zitat Brede CM, Shoskes DA (2011) The etiology and management of acute prostatitis. Nat Rev Urol 8(4):207–212CrossRefPubMed Brede CM, Shoskes DA (2011) The etiology and management of acute prostatitis. Nat Rev Urol 8(4):207–212CrossRefPubMed
7.
Zurück zum Zitat Cafferkey MT, Falkiner FR, Gillespie WA, Murphy DM (1982) Antibiotics for the prevention of septicaemia in urology. J Antimicrob Chemother 9(6):471–477CrossRefPubMed Cafferkey MT, Falkiner FR, Gillespie WA, Murphy DM (1982) Antibiotics for the prevention of septicaemia in urology. J Antimicrob Chemother 9(6):471–477CrossRefPubMed
8.
Zurück zum Zitat Caljouw MA, van den Hout WB, Putter H et al (2014) Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons: a double-blind randomized placebo-controlled trial in long-term care facilities. JAGS 62:103–110CrossRef Caljouw MA, van den Hout WB, Putter H et al (2014) Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons: a double-blind randomized placebo-controlled trial in long-term care facilities. JAGS 62:103–110CrossRef
9.
Zurück zum Zitat Carnell J, Fischer J, Nagdev A (2011) Ultrasound detection of obstructive pyelonephritis due to urolithiasis in the ED. Am J Emerg Med 29(7):843CrossRefPubMed Carnell J, Fischer J, Nagdev A (2011) Ultrasound detection of obstructive pyelonephritis due to urolithiasis in the ED. Am J Emerg Med 29(7):843CrossRefPubMed
10.
Zurück zum Zitat Engelhart ST, Hanses-Derendorf L, Exner M, Kramer MH (2005) Prospective surveillance for healthcare-associated infections in German nursing home residents. J Hosp Infect 60:46–50CrossRefPubMed Engelhart ST, Hanses-Derendorf L, Exner M, Kramer MH (2005) Prospective surveillance for healthcare-associated infections in German nursing home residents. J Hosp Infect 60:46–50CrossRefPubMed
11.
Zurück zum Zitat Eriksson I, Gustafson Y, Fagerstrom L et al (2011) Urinary tract infection in very old women is associated with delirium. Int Psychogeriatr 23(3):496–502CrossRefPubMed Eriksson I, Gustafson Y, Fagerstrom L et al (2011) Urinary tract infection in very old women is associated with delirium. Int Psychogeriatr 23(3):496–502CrossRefPubMed
12.
Zurück zum Zitat Esparcia A, Artero A, Eiros JM, Balaguer M et al (2014) Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections. Eur J Intern Med 25(6):523–527CrossRefPubMed Esparcia A, Artero A, Eiros JM, Balaguer M et al (2014) Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections. Eur J Intern Med 25(6):523–527CrossRefPubMed
13.
Zurück zum Zitat Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity and economic costs. Am J Med 113:5S–13SCrossRefPubMed Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity and economic costs. Am J Med 113:5S–13SCrossRefPubMed
14.
Zurück zum Zitat Gavazzi G, Delerce E, Cambau E et al (2013) Diagnostic criteria for urinary tract infection in hospitalized elderly patients over 75 years of age: a multicenter cross-sectional study. Med Mal Infect 43(5):189–194CrossRefPubMed Gavazzi G, Delerce E, Cambau E et al (2013) Diagnostic criteria for urinary tract infection in hospitalized elderly patients over 75 years of age: a multicenter cross-sectional study. Med Mal Infect 43(5):189–194CrossRefPubMed
15.
Zurück zum Zitat Geerlings SE (2008) Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents 31:S54–S57CrossRefPubMed Geerlings SE (2008) Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents 31:S54–S57CrossRefPubMed
16.
Zurück zum Zitat Gokula RM, Hickner JA, Smith MA (2004) Inappropriate use of urinarycatheters in elderly patients at a mid-western community teaching hospital. Am J Infect Control 32:196–199CrossRefPubMed Gokula RM, Hickner JA, Smith MA (2004) Inappropriate use of urinarycatheters in elderly patients at a mid-western community teaching hospital. Am J Infect Control 32:196–199CrossRefPubMed
17.
Zurück zum Zitat Gould CV, Umscheid CA, Agarwal RK et al (2010) Guideline for the prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 31:319–326CrossRefPubMed Gould CV, Umscheid CA, Agarwal RK et al (2010) Guideline for the prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 31:319–326CrossRefPubMed
18.
Zurück zum Zitat Grabe M, Forsgren A, Bjork T, Hellsten S (1987) Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral prostatic surgery. Eur J Clin Microbiol 6(1):11–17CrossRefPubMed Grabe M, Forsgren A, Bjork T, Hellsten S (1987) Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral prostatic surgery. Eur J Clin Microbiol 6(1):11–17CrossRefPubMed
19.
Zurück zum Zitat High KP, Bradley S, Loeb M, Palmer R, Quagliarello V, Yoshikawa T (2005) A new paradigm for clinical investigation of infectious syndromes in older adults: assessment of functional status as a risk factor and outcome measure. Clin Infect Dis 40:114–122CrossRefPubMed High KP, Bradley S, Loeb M, Palmer R, Quagliarello V, Yoshikawa T (2005) A new paradigm for clinical investigation of infectious syndromes in older adults: assessment of functional status as a risk factor and outcome measure. Clin Infect Dis 40:114–122CrossRefPubMed
20.
Zurück zum Zitat Hwang EC, Jung SI, Kwon DD, Lee G, Bae JH, Na YG (2014) A prospective korean multicenter study for infectious complications in patients undergoing prostate surgery: risk factors and efficacy of antibiotic prophylaxis. J Korean Med Sci 29(9):1271–1277PubMedCentralCrossRefPubMed Hwang EC, Jung SI, Kwon DD, Lee G, Bae JH, Na YG (2014) A prospective korean multicenter study for infectious complications in patients undergoing prostate surgery: risk factors and efficacy of antibiotic prophylaxis. J Korean Med Sci 29(9):1271–1277PubMedCentralCrossRefPubMed
21.
Zurück zum Zitat Jepson R, Craig J (2008) Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev (1):CD001321 Jepson R, Craig J (2008) Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev (1):CD001321
22.
Zurück zum Zitat Krein SL, Kowalski CP, Hofer TP et al (2012) Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009. J Gen Intern Med 27:773–779PubMedCentralCrossRefPubMed Krein SL, Kowalski CP, Hofer TP et al (2012) Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009. J Gen Intern Med 27:773–779PubMedCentralCrossRefPubMed
23.
Zurück zum Zitat KRINKO (2014) Empfehlungen zur Prävention und Kontrolle Katheter-assoziierter Harnwegsinfektionen* Mitteilung der Kommission für Krankenhaushygiene und Infektionsprävention am Robert Koch-Institut (nach Entwurf vom 29.09.2014) KRINKO (2014) Empfehlungen zur Prävention und Kontrolle Katheter-assoziierter Harnwegsinfektionen* Mitteilung der Kommission für Krankenhaushygiene und Infektionsprävention am Robert Koch-Institut (nach Entwurf vom 29.09.2014)
24.
Zurück zum Zitat Lipsky BA, Inui TS, Plorde JJ, Berger RE (1984) Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men? Am J Med 76(2):257–262CrossRefPubMed Lipsky BA, Inui TS, Plorde JJ, Berger RE (1984) Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men? Am J Med 76(2):257–262CrossRefPubMed
25.
Zurück zum Zitat Lujan GM, Paez BA, Fernandez G, I, Llorente AC, Romero C, I, Bustamante AS et al (1997) Usefulness of ultrasonography in the assessment of acute pyelonephritis. Arch Esp Urol 50(1):46–50 Lujan GM, Paez BA, Fernandez G, I, Llorente AC, Romero C, I, Bustamante AS et al (1997) Usefulness of ultrasonography in the assessment of acute pyelonephritis. Arch Esp Urol 50(1):46–50
26.
Zurück zum Zitat Lutters M, Vogt-Ferrier NB (2008) Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. The Cochrane Library 2008, Issue 3 Lutters M, Vogt-Ferrier NB (2008) Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. The Cochrane Library 2008, Issue 3
29.
Zurück zum Zitat McMurdo ME, Argo I, Phillips G, Daly F, Davey P (2009) Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother 63:389–395PubMedCentralCrossRefPubMed McMurdo ME, Argo I, Phillips G, Daly F, Davey P (2009) Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother 63:389–395PubMedCentralCrossRefPubMed
30.
Zurück zum Zitat Meddings J et al (2014) Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review, BMJ Qual Saf 23:277–289. doi:10.1136/bmjqs-2012-001774PubMedCentralCrossRefPubMed Meddings J et al (2014) Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review, BMJ Qual Saf 23:277–289. doi:10.1136/bmjqs-2012-001774PubMedCentralCrossRefPubMed
31.
Zurück zum Zitat Michael L, Grover DO, Jesse D et al (2009) Urinary tract infection in women over the age of 65: is age alone a marker of complication? J Am Board Fam Med 22(3):266–271. doi:10.3122/jabfm.2009.03.080123CrossRef Michael L, Grover DO, Jesse D et al (2009) Urinary tract infection in women over the age of 65: is age alone a marker of complication? J Am Board Fam Med 22(3):266–271. doi:10.3122/jabfm.2009.03.080123CrossRef
32.
Zurück zum Zitat Mims AD, Norman DC, Yamamura RH, Yoshikawa TT (1990) Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings. J Am Geriatr Soc 38(11):1209–1214CrossRefPubMed Mims AD, Norman DC, Yamamura RH, Yoshikawa TT (1990) Clinically inapparent (asymptomatic) bacteriuria in ambulatory elderly men: epidemiological, clinical, and microbiological findings. J Am Geriatr Soc 38(11):1209–1214CrossRefPubMed
34.
Zurück zum Zitat Nace DA, Drinka PJ, Crnich CJ (2014) Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc 15(2):133–139CrossRefPubMed Nace DA, Drinka PJ, Crnich CJ (2014) Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc 15(2):133–139CrossRefPubMed
35.
Zurück zum Zitat Nicolle LE (2003) Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 17(2):367–394CrossRefPubMed Nicolle LE (2003) Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 17(2):367–394CrossRefPubMed
36.
37.
Zurück zum Zitat Nielsen KL, Dynesen P, Larsen P, Frimodt-Møller N (2014) Faecal Escherichia coli from patients with E. coli urinary tract infection and healthy controls who have never had a urinary tract infection. J Med Microbiol 63(Pt 4):582–589CrossRefPubMed Nielsen KL, Dynesen P, Larsen P, Frimodt-Møller N (2014) Faecal Escherichia coli from patients with E. coli urinary tract infection and healthy controls who have never had a urinary tract infection. J Med Microbiol 63(Pt 4):582–589CrossRefPubMed
38.
Zurück zum Zitat Perrotta C, Aznar M, Mejia R, Albert X, Ng CW (2008) Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Obstet Gynecol 112:689–690CrossRefPubMed Perrotta C, Aznar M, Mejia R, Albert X, Ng CW (2008) Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Obstet Gynecol 112:689–690CrossRefPubMed
39.
Zurück zum Zitat Pickard R, Lam T, Maclennan G et al (2012) Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicenter randomised controlled trial. Lancet 380:1927–1935CrossRefPubMed Pickard R, Lam T, Maclennan G et al (2012) Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicenter randomised controlled trial. Lancet 380:1927–1935CrossRefPubMed
40.
Zurück zum Zitat Piechota H, Pannek J (2007) Catheter drainage of the urinary bladder – current standards for the prevention of catheter-associated urinary tract infection. Hyg Med 32 (9):336–344 Piechota H, Pannek J (2007) Catheter drainage of the urinary bladder – current standards for the prevention of catheter-associated urinary tract infection. Hyg Med 32 (9):336–344
41.
Zurück zum Zitat Prieto-Gonzalez S, Alemany M (2014) Images in clinical medicine. Chronic obstructive pyelonephritis. N Engl J Med 371(14):1332CrossRefPubMed Prieto-Gonzalez S, Alemany M (2014) Images in clinical medicine. Chronic obstructive pyelonephritis. N Engl J Med 371(14):1332CrossRefPubMed
42.
Zurück zum Zitat Rogers MA, Fries BE, Kaufman SR et al (2008) Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study. BMC Geriatr 8:31. doi:10.1186/1471-2318-8-31PubMedCentralCrossRefPubMed Rogers MA, Fries BE, Kaufman SR et al (2008) Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study. BMC Geriatr 8:31. doi:10.1186/1471-2318-8-31PubMedCentralCrossRefPubMed
43.
Zurück zum Zitat Schiller DS, Parikh A (2011) Identification, pharmacologic considerations, and management of prostatitis. Am J Geriatr Pharmacother 9(1):37–48CrossRefPubMed Schiller DS, Parikh A (2011) Identification, pharmacologic considerations, and management of prostatitis. Am J Geriatr Pharmacother 9(1):37–48CrossRefPubMed
44.
Zurück zum Zitat Sharp VJ, Takacs EB, Powell CR (2010) Prostatitis: diagnosis and treatment. Am Fam Physician 82(4):397–406PubMed Sharp VJ, Takacs EB, Powell CR (2010) Prostatitis: diagnosis and treatment. Am Fam Physician 82(4):397–406PubMed
45.
Zurück zum Zitat Stahlmann R, Lode HM (2013) Risks associated with the therapeutic use of fluoroquinolones. Expert Opin Drug Saf 12(4):497–505CrossRefPubMed Stahlmann R, Lode HM (2013) Risks associated with the therapeutic use of fluoroquinolones. Expert Opin Drug Saf 12(4):497–505CrossRefPubMed
46.
Zurück zum Zitat Stamm WE, Raz R (1999) Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections. Clin Infect Dis 28:723–725CrossRefPubMed Stamm WE, Raz R (1999) Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections. Clin Infect Dis 28:723–725CrossRefPubMed
47.
Zurück zum Zitat Sussman M, Evans JA, Asscher AW et al (1972) The natural history of asymptomatic bacteriuria. J Med Microbiol 5(4):xi Sussman M, Evans JA, Asscher AW et al (1972) The natural history of asymptomatic bacteriuria. J Med Microbiol 5(4):xi
48.
Zurück zum Zitat Tenke P et al (2008) European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 31(Suppl 1):S68–S78CrossRefPubMed Tenke P et al (2008) European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 31(Suppl 1):S68–S78CrossRefPubMed
49.
Zurück zum Zitat Wagenlehner FM, Pilatz A, Bschleipfer T et al (2013) Bacterial prostatitis. World J Urol 31(4):711–716CrossRefPubMed Wagenlehner FM, Pilatz A, Bschleipfer T et al (2013) Bacterial prostatitis. World J Urol 31(4):711–716CrossRefPubMed
Metadaten
Titel
Harnwegsinfekte im Alter
verfasst von
Dr. med. Klaus Friedrich Becher, MHBA, M.D.
Dr. Ingo Klempien, M.D.
Priv.-Doz. Dr. Andreas Wiedemann, M.D., PHD
Publikationsdatum
01.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 7/2015
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-015-0947-3

Weitere Artikel der Ausgabe 7/2015

Zeitschrift für Gerontologie und Geriatrie 7/2015 Zur Ausgabe

Mitteilungen des Bundesverbands Geriatrie

Mitteilungen des Bundesverbands Geriatrie

Journal Club

Journal Club