From the Guidelines
Elderly men are more prone to developing urinary tract infections (UTIs) primarily due to prostate enlargement, which leads to incomplete bladder emptying and creates an environment conducive to bacterial growth. This condition, known as benign prostatic hyperplasia (BPH), is highly prevalent among men over 60 years of age, with its prevalence increasing significantly with age 1. Other factors contributing to the increased risk of UTIs in elderly men include decreased immune function, reduced mobility making proper hygiene challenging, and chronic conditions such as diabetes that impair the immune response and create favorable conditions for bacterial growth due to higher sugar levels in urine 1. The use of catheters, which is common among elderly men with urinary issues, provides a direct pathway for bacteria to enter the urinary tract, further increasing the risk of UTIs. Decreased fluid intake, often seen in older adults, results in more concentrated urine and less frequent urination, allowing bacteria to multiply. Additionally, changes in the urinary tract's protective mechanisms and increased bacterial colonization in the genital area contribute to UTI susceptibility.
Key factors associated with complicated urinary tract infections, which are more common in elderly men, include obstruction at any site in the urinary tract, diabetes mellitus, immunosuppression, and the presence of multidrug-resistant organisms 1. The management of UTIs in elderly men, especially those who are frail or have comorbid conditions, requires careful consideration of potential drug interactions, contraindications, and the need for tailored antimicrobial therapy based on local resistance patterns and specific host factors 1. Given the complexity and potential severity of UTIs in this population, prompt medical attention is crucial when symptoms occur, as UTIs can quickly progress to serious kidney infections or sepsis.
The most recent guidelines emphasize the importance of appropriate management of underlying urological abnormalities, optimal antimicrobial therapy, and consideration of the patient's overall health status and potential for drug interactions 1. In the context of real-life clinical practice, prioritizing the patient's quality of life, morbidity, and mortality outcomes is essential when making treatment decisions for elderly men with UTIs.
From the Research
Reasons for Elderly Men to Develop Urinary Tract Infections (UTIs)
- Age-related changes, such as a decline in cell-mediated immunity, neurogenic bladder dysfunction, and structural urinary tract abnormalities (e.g., benign prostatic hyperplasia) 2
- Systemic diseases, such as diabetes mellitus 2
- Increased incidence of urethral catheter placement, with catheter-associated bacteriuria being the most common hospital-acquired infection 2
- Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS), which can cause obstructive uropathy and increase the risk of UTIs 3
- Polypharmacy and the presence of other comorbidities, which can affect the treatment outcomes of UTIs 4
- Indwelling urethral catheters, which can increase the risk of UTIs, and their continued use should be regularly reviewed 5
Factors Associated with UTI Development
- Gender, with males being more likely to develop UTIs 4
- Presence of comorbidities, such as prostate enlargement and an overactive bladder 6
- Use of antimicrobial agents, which should be guided by current surveillance studies of targeted uropathogenic bacteria 2