What Are the Symptoms of Urinary Tract Infections in the Elderly?

Non-specific pyelonephritis, cystitis, and proliferative prostatitis are more common in the elderly. Symptoms include back pain, urgency, frequent urination, and fever. Acute high fever with chills and increased white blood cells are often misdiagnosed early due to insignificant urinary tract symptoms. Chronic phase may appear fatigue, back pain, anemia, hypertension, pyuria, proteinuria. It varies with individual performance, but gradual progress can affect renal function. In addition to bladder irritation symptoms, hematuria is more common in the elderly.

Urinary tract infections in the elderly

Non-specific pyelonephritis, cystitis, and proliferative prostatitis are more common in the elderly. Symptoms include back pain, urgency, frequent urination, and fever. Acute high fever with chills and increased white blood cells are often misdiagnosed early due to insignificant urinary tract symptoms. Chronic phase may appear fatigue, back pain, anemia, hypertension, pyuria, proteinuria. With one

(1) Decreased autoimmune ability 1. The defense function of systemic factors is gradually weakened: the normal person's urinary tract has a better defense ability against the invasion of foreign bacteria. Urine outflow can remove bacteria; in vitro and in vitro: some high-concentration substances in the urine such as urea, and the acidic environment in the urinary tract can inhibit the growth of bacteria. For the elderly, the defense mechanism of the urinary tract has changed:
As the age increases, the bladder contracts weakly, and the micturition reflex gradually weakens. There is still more urine in the bladder after urination, and even urinary retention occurs.
Men over 60 years old are often accompanied by benign prostatic hyperplasia or hypertrophy, elderly women are prone to bladder neck obstruction, and elderly people are susceptible to urinary tract stones and other diseases, which can lead to poor urination, and sometimes need catheterization, thereby increasing urine Chance of road infection. According to statistics from some people, the infection rate of urinary drainage in young people is only 1%, while that of elderly people can be as high as 5% -10%.
Degenerative lesions in the kidney and urinary tract of the elderly, and local mucosal resistance is low.
The immune function of the elderly declines, and their resistance to various bacteria also declines. Due to the above changes, the elderly suffer from urinary tract infections, and they are not easily cured or recurrent.
2. Inadequate treatment of acute attacks Due to weak resistance, the elderly need a sufficient amount of sensitive antibiotics for treatment. However, many elderly patients often fail to complete the full course of treatment or cannot follow up to the hospital as required by the doctor due to medical expenses, inconvenience of medical treatment, etc., resulting in incomplete treatment.
(2) Increased precipitating factors 1. Elderly people with systemic factors often suffer from diabetes, chronic renal insufficiency, cerebrovascular accidents, fractures, tumors, trauma, and other chronic diseases. They often stay in bed for long periods and use hormones and immunosuppressants. Increases the chance of urinary tract infection.
2. Local factors Elderly patients are prone to urinary system infection due to prostate disease, bladder tumors, urinary stones, bladder neck sclerosis, and female uterine prolapse, etc. . Bacteria multiply very quickly in the bladder urine, which is poorly drained. Chronic bacterial prostatitis is the most common cause of mucous recurrent urinary tract infections in the elderly.
3. Iatrogenic factors The elderly need to perform a variety of urethral procedures due to prostate hyperplasia, cerebrovascular accidents and urinary tumors, such as urinary catheterization, urethral surgery, cystoscopy, especially indwelling catheters and cystostomy Later, it is more likely to cause local damage and invasion of germs, which significantly increases the probability of acquired urinary tract infections in the elderly hospitals. In elderly patients with other systemic infections, the use of broad-spectrum antibiotics in long-term relatively large doses has caused some patients to develop urinary mold. infection.
(3) Common pathogenic bacteria have different urinary tract infections. Most of them are caused by aerobic bacteria. Anaerobes only occur in patients without rectal bladder fistula or other abnormal communication between urinary and intestinal tract. The most common pathogenic bacteria of urinary tract infections in young people, especially women, are E. coli, and the proportion of urinary tract infections in the elderly is obvious. The infection rates of Proteus, Klebsiella, Pseudomonas aeruginosa, Enterococcus, and other Gram-positive bacteria, molds, and chlamydia have also gradually increased. This is because the urinary tract infections in the elderly are mostly chronic, recurrent, and hospital or Acquired infections in the community. Due to the widespread use of antibiotics, urinary tract infections caused by drug-resistant bacteria are also increasing.

(I) Atypical symptoms of urinary tract irritation Except for patients with acute lower urinary tract infections, most of the elderly patients with urinary tract infections do not have single-line urinary tract irritation symptoms such as urinary frequency, urgency, and dysuria, so it is difficult to rely on urinary tract irritation symptoms in a timely manner. Urinary tract infections found in the elderly. Elderly people without urinary tract infections may also experience symptoms such as frequent urination and urinary incontinence, and only about 1/3 of elderly patients diagnosed with urinary tract infections have more typical symptoms of acute urinary tract irritation.
(2) Asymptomatic and non-specific symptoms increase Asymptomatic means no symptoms such as dysuria, frequent urination, dysuria, recent incontinence, fever, etc. The white blood cells are not elevated on the blood test, but the urine specimen has 105 / ml colonies. . On the one hand, this is due to the low immunity of the elderly and their poor response to infections. On the other hand, most of them are due to various diseases often existing in the elderly. The symptoms of other diseases may obscure the systemic and local symptoms of urinary tract infections.
(3) Recurrent pus and low detection rate of bacteriuria. Due to the weakened local and systemic immunity of the urinary tract, elderly men have different urinary dysfunctions, which have caused recurrent episodes of urinary tract infections in the elderly. Pyuria is helpful in the diagnosis of urinary tract infections, but urinary tract infections caused by Proteus and Staphylococcus, which are prone to leukocyte disintegration and decomposing urea into ammonia, are more common in the elderly, making the rate of pyuria and bacteriuria low. . Bacteria in urine can convert nitrate to nitrite, and the determination of nitrite in urine can provide a rapid and semi-quantitative bacterial detection method. The experiment has high sensitivity and specificity, but the disadvantage is that the species of bacteria cannot be determined.
The diagnosis of urinary tract infection in the elderly is mainly based on medical history and urine test results. However, the urine test results of the elderly are often inconsistent with the symptoms, and comprehensive analysis and judgment can prevent misdiagnosis and missed diagnosis. For recurrent urinary tract infections, it is necessary to find out the existence of the primary disease.

The elderly have different non-specific exudation of urinary inflammatory cells, which makes the judgment criteria different. Young people with urinary sediment leukocytes> 4 / high power field have pathological significance, while the elderly require> 20 / high power field. Pathological significance. The number of middle-aged urine culture colonies in elderly men is 103 / ml, and for women, the standard is 105 / ml.

Urine induction is distinguished from the following diseases.
1. Fever disease When the symptoms of systemic infection such as acute urinary sensation and fever are prominent, but local urinary tract symptoms are not obvious, it is easy to be confused with febrile diseases, such as influenza, malaria, sepsis, typhoid, etc., accounting for about 40 of misdiagnosed cases. %. However, if you can inquire about the medical history in detail, pay attention to the local symptoms of urinary sensation, and make a urine sediment and bacteriological examination, it is not difficult to identify.
2. Abdominal organ inflammation In some cases, there may be no local symptoms of urinary sensation, but it is manifested as abdominal pain, nausea, vomiting, fever, increased white blood cell count, etc., which is easily misdiagnosed as acute gastroenteritis, appendicitis, and women's accessory inflammation. In time, urine routine and urine bacteriological examination can be identified.
3. Urethral syndrome is also called aseptic frequent urination and urination discomfort syndrome. Stamm et al. Pointed out that women with lower urinary tract symptoms, that is, those with frequent urination, urgency, dysuria or dysuria, and pain in the bladder area, can be divided into two groups. About 70% of patients have pyuria and bacterial urine (which can only be 100 / ml), which is a true urinary sensation; and about 30% of patients are not true urinary sensation. Urethral syndrome refers to patients who have only frequent urination, dysuria, and no bacterial urine. According to our experience, urethral syndrome is very common in the clinic and is often misdiagnosed as urinary sensation by primary doctors, and long-term use of antibacterial drugs. In patients with urethral syndrome, after the urinary tract tuberculosis, fungi and anaerobic infections are indeed ruled out, the next step should be to determine the possibility of chlamydia urinary tract infection. However, these patients often have a history of unclean sex and white blood cells in the urine. After taking tetracycline for 7 to 10 days, the symptoms will disappear, and the diagnosis is not difficult. If the above-mentioned possibility can be ruled out in order, the patient can be diagnosed as non-microbiologically caused urethral syndrome, which is more common in middle-aged women. Frequent urination is often more prominent than micturition discomfort, and often has a long history of antibiotics and is ineffective. The cause is unknown, some people think it may be related to local urinary tract irritation or allergies, such as topical contraceptives or tools, bath liquids, deodorant sprays, etc .; some people think it may be abnormal urinary dysfunction, especially detrusive Ataxia of the muscles and sphincter; some people also believe that some non-infectious non-specific inflammatory diseases of the lower urinary tract can also be caused. Based on our limited experience, most of these patients are caused by anxiety neurosis, and they have obvious psychological factors. When distracted, the symptoms of frequent urination can be significantly reduced. Long-term use of diazepam has a certain effect.
4. Renal tuberculosis is mainly manifested by hematuria, bladder irritation is obvious, and it is easy to be misdiagnosed as renal tuberculosis. However, the bladder irritation symptoms of renal tuberculosis are more prominent; the morning urine tuberculosis culture can be positive, but the ordinary bacterial culture is negative; urinary sediment can find acid-fast bacilli; intravenous pyelography can detect the renal tuberculosis X-ray signs; some patients can have lungs, genitals Extrarenal tuberculosis lesions and effective antituberculosis treatment can be identified. However, it should be noted that renal tuberculosis can often coexist with ordinary urine sensation. Therefore, if the patient still has frequent urination, dysuria symptoms or abnormal urine sediment after active antibacterial treatment, he should pay close attention to the possibility of renal tuberculosis, and it should be checked accordingly.
5. Chronic glomerulonephritis is not difficult to identify if it has edema or a large amount of proteinuria. The amount of urinary protein in pyelonephritis is generally below 1-2g / d, and if it is> 3g, it is mostly glomerular disease. However, this disease is difficult to distinguish from occult nephritis, which has more red blood cells in urine, while pyelonephritis is mainly white blood cells. In addition, urine culture, long-term observation of patients with low fever, frequent urination and other symptoms can also help identify. When advanced glomerulonephritis is secondary to urinary tract infection, identification is difficult. At this time, a detailed medical history can be asked and analyzed in combination with clinical characteristics.
6. Prostatitis Men over 50 years of age are prone to this disease when they have benign prostatic hyperplasia, hypertrophy, placement of a catheter, or cystoscopy. Frequent urination, dysuria, and pus cells on urine tests are often confused with acute cystitis. However, in addition to chills, fever, and an increase in the total number of white blood cells, acute prostatitis may have pain in the lumbosacral region and perineum, resulting in restlessness. Clinical symptoms of chronic prostatitis are not obvious except for abnormal urine tests. Prostate fluid was obtained from prostate massage for examination. It was found that the number of white blood cells was more than 10 / HP. B ultrasound of the prostate was helpful for differential diagnosis.
7. Tubulointerstitial nephritis A variety of tubulointerstitial nephritis, such as reactive tubulointerstitial nephritis (tubular interstitial nephritis caused by systemic infection), allergic tubulointerstitial nephritis (drug-related acute tubules) Interstitial nephritis), non-steroidal anti-inflammatory drug-related nephropathy, heavy metal toxic nephropathy, radiation nephritis, reflux nephropathy, etc., can cause pyuria, but they are aseptic pyuria, and bacterial culture is negative. Acute infectious tubulointerstitial nephritis caused by bloodstream infection has recently increased. Our department diagnoses and treats more than 10 cases of acute infectious tubulointerstitial nephritis caused by drug-related systemic infections every year.
8. Hypercalciuria Hypercalciuria can cause frequent urination, urgency, and dysuria, but generally no pyuria, negative bacterial culture, urine ca / Cr ratio and 24h urine calcium increased.
9. When hematuria causes a lot of hematuria, it can cause frequent urination, urgency, and dysuria, but the white blood cells in urine are significantly less than red blood cells. Further examination can often find the primary diseases that cause hematuria.