From the Guidelines
The mortality rate of post-operative urinary tract infections (UTIs) in geriatric patients is approximately 11.9% for UTIs and 1.8% for pyelonephritis, with a significant increase in mortality risk when UTIs progress to urosepsis, as reported in a large population-based study from 2003 to 2013 1. This mortality risk is influenced by several factors, including age-related immune senescence, higher prevalence of comorbidities such as diabetes and renal insufficiency, functional impairments, and the presence of urinary catheters which are common after surgery. Early detection and prompt treatment are crucial for reducing mortality, with treatment typically involving empiric antibiotic therapy with agents like ciprofloxacin, trimethoprim-sulfamethoxazole, or nitrofurantoin for 7-10 days, with adjustments based on culture results and renal function 1. For more severe infections, initial intravenous therapy with ceftriaxone or piperacillin-tazobactam may be necessary. Prevention strategies include minimizing catheter use, early removal when possible, maintaining proper hydration, and implementing comprehensive geriatric assessments post-surgery to identify and address risk factors promptly. It is essential to consider the atypical symptoms of UTIs in older adults, such as altered mental status, functional decline, fatigue, or falls, and to take into account potential drug interactions and contraindications, such as impaired kidney function, when selecting treatment 1. The administration of perioperative antibiotics is also crucial in preventing postoperative UTIs, and the AUA’s best practice policy statement on urologic surgery antimicrobial prophylaxis provides guidelines for the appropriate use of periprocedural antimicrobial prophylaxis 1. Overall, a comprehensive approach to prevention, early detection, and treatment of post-operative UTIs in geriatric patients is necessary to reduce morbidity, mortality, and improve quality of life. Key considerations include:
- Minimizing catheter use and early removal when possible
- Maintaining proper hydration
- Implementing comprehensive geriatric assessments post-surgery
- Selecting appropriate antibiotic therapy based on culture results and renal function
- Considering potential drug interactions and contraindications
- Administering perioperative antibiotics according to guidelines.
From the Research
Mortality Rate of Post-Op UTI in Geriatric Patients
- The mortality rate of post-operative urinary tract infections (UTIs) in geriatric patients is a significant concern, with varying rates reported in different studies 2, 3, 4.
- A study published in 2022 found that geriatric patients who developed postoperative UTI had a lower mortality rate (1.36% vs. 2.2%, p < 0.001) compared to those without UTI 2.
- In contrast, a study published in 2018 reported a mortality rate of 17.89% in elderly patients with UTI, with significantly higher mortality rates in patients with diabetes mellitus, complicated UTI, dementia, and elevated serum creatinine levels 3.
- Another study published in 2018 found a mortality rate of 5% in geriatric patients with UTI, highlighting the need for immediate empirical treatment and careful monitoring of these patients 4.
Risk Factors for Mortality
- Several risk factors have been identified as contributing to mortality in geriatric patients with UTI, including:
Clinical Implications
- The studies suggest that postoperative UTI is a significant complication in geriatric patients, associated with increased morbidity, mortality, and length of hospital stay 2, 3, 4.
- Early recognition and treatment of UTI are crucial to prevent serious complications and reduce mortality rates in this population 3, 4.
- Further research is needed to identify effective strategies for preventing and managing UTI in geriatric patients, particularly in the postoperative setting 2, 5.