From the Guidelines
Elderly men are at risk of developing urinary tract infections (UTIs) due to factors such as enlarged prostate, incomplete bladder emptying, decreased immune function, catheter use, and underlying conditions like diabetes, and they may exhibit typical symptoms like burning during urination, increased urinary frequency and urgency, as well as less typical symptoms like sudden confusion, agitation, or fatigue 1. The reasons for UTIs in elderly men are multifaceted, including:
- Enlarged prostate (benign prostatic hyperplasia) which obstructs urine flow
- Incomplete bladder emptying
- Decreased immune function
- Catheter use
- Underlying conditions like diabetes Symptoms of UTIs in elderly men may include:
- Burning during urination
- Increased urinary frequency and urgency
- Cloudy or bloody urine
- Strong-smelling urine
- Lower abdominal pain
- Fever or confusion in severe cases
- Less typical symptoms such as sudden confusion, agitation, fatigue, or worsening of existing conditions without the classic urinary symptoms It is essential to note that the diagnosis of UTI in older patients should be based on typical symptoms in combination with detection of pathogens in the urine, and that mere detection of bacteriuria does not confirm UTI due to the high prevalence of asymptomatic bacteriuria (ABU) in this population 1. The management of UTIs in elderly men should take into account potential drug interactions and contraindications, and treatment selection should consider comorbidities, polypharmacy, and potential adverse events to optimize outcomes in this vulnerable population 1. In terms of treatment, antibiotics such as trimethoprim-sulfamethoxazole (Bactrim), nitrofurantoin (Macrobid), or fluoroquinolones like ciprofloxacin may be used for 7-14 days, depending on severity, and it is crucial to drink plenty of water, urinate frequently, and complete the full course of antibiotics to ensure recovery 1. If symptoms persist or worsen despite treatment, medical attention should be sought promptly as complications like kidney infections can develop, especially in older adults with compromised immune systems.
From the Research
Reasons for Urinary Tract Infections (UTIs) in Elderly Men
- Benign prostatic hyperplasia (BPH) is a common condition in older men that can increase the risk of UTIs 2, 3
- Age-related changes, such as metabolic disturbances, changes in hormone balance, and chronic inflammation, can contribute to the development of BPH and subsequent UTIs 2
- The use of dipeptidyl peptidase-4 (DPP-4) inhibitors, a type of antidiabetic drug, may increase the risk of UTIs in elderly patients, particularly those with prostatic hyperplasia 4
- Other factors, such as an overactive bladder, prostate enlargement, and an indwelling bladder catheter, can also contribute to the development of UTIs in elderly men 5
Symptoms of Urinary Tract Infections (UTIs) in Elderly Men
- Lower urinary tract symptoms (LUTS) are common in elderly men with UTIs, and can include:
- Nocturia (waking up to urinate at night)
- Urgency (a sudden need to urinate)
- Frequency (urinating more often than usual)
- Weak urinary stream
- Straining to urinate
- A sensation of not completely emptying the bladder 3
- Other symptoms of UTIs in elderly men may include:
Microbiological Epidemiology of UTIs in Elderly Men
- The most common organisms causing UTIs in elderly men are:
- Escherichia coli (E. coli)
- Klebsiella spp.
- Enterococcus spp. 6
- The use of antibiotics, community care treatment, and permanent urinary catheters can increase the risk of developing antibiotic-resistant organisms, such as extended-spectrum beta-lactamases (ESBL)-producing E. coli and Klebsiella spp. 6