Service de gériatrie, CHU de Poitiers, Service de maladies infectieuses, CHG d’Annecy, Département de santé publique, CHU de Grenoble, Département de bactériologie, Hôpital Saint-Louis, Paris, Service de gériatrie, CHU de Lille, Service de médecine interne et gériatrie, Nîmes, Service de gériatrie, CHU de Grenoble
French diagnostic and therapeutic recommendations about UI were built-up in 2008. We studied clinician's practices and evaluated the adequacy to the recommendations in hospitalized patients aged over 75 years.
Method: Multicenter survey in acute care of geriatric, internal medicine and infectious disease wards. During one week, all positive urine cultures of patients over 75 were reported to the local investigator who had to fill out a questionnaire. The data specified the final diagnosis: cystitis, pyelonephritis, prostatitis, or colonization, the antibiotic treatment, the re-evaluation after 72 hours of treatment, the association with another infectious diagnosis and the radiological examinations performed.
Results: 241 questionnaires were collected from 48 wards. Colonization, cystitis, pyelonephritis and prostatitis were diagnosed respectively in 42, 27, 20 and 11% of urine cultures. In 48% of cystitis cases, the duration of treatment was inadequate. In 77% cases of pyelonephritis, the antibiotic was adapted to the recommendations, but 44% of patients had no further radiological examination. In cases of prostatitis antibiotic therapy was adequate in 74% of cases but often with a non-conform duration of treatment (56%) and absence of further radiographic examination (70%). The reassessment of the treatment at day 3 ranged from 63 to 88%. In 26% of UI diagnosis, another associated infection was described, mainly bronchopneumonia (56%).
Conclusion: Progress is needed to optimize treatment revaluation at 72 hours and adequate duration of treatment. The association of UI and bronchopneumonia is questionable. More specific recommendations would probably be useful to optimize the management of UI in the elderly.