YAŞLI YETİŞKİNLERDE İDRAR YOLU ENFEKSİYONLARININ TANIMLAYICI ÖZELLİKLERİ, ETİYOLOJİK AJANLAR VE MORTALİTE RİSK FAKTÖRLERİ

Öz

AMAÇ: İdrar yolu enfeksiyonları yaşlı erişkinlerde sıklıkla görülmekte ve önemli morbidite ve mortalite ile ilişkilendirilmektedir. Bu çalışmanın amacı, idrar yolu enfeksiyonu ile hastaneye yatırılan yaşlı hastaların klinik özelliklerini, bakteriyel etiyolojilerini, antimikrobiyal direnç paternlerini ve mortalite için risk faktörlerini karakterize etmektir. GEREÇ VE YÖNTEM: Ocak 2018 ile Aralık 2022 tarihleri arasında idrar yolu enfeksiyonu tanısıyla hastaneye yatırılan ≥65 yaş 118 hastanın verileri retrospektif olarak analiz edilmiştir. İdrar yolu enfeksiyonları Hastalık Kontrol ve Korunma Merkezleri (Centers for Disease Control and Prevention) kriterlerine göre tanımlanmıştır. İdrar kültürlerinde izole edilen mikroorganizmalar ve antimikrobiyal direnç oranları belirlenmiştir. Mortalite ile ilişkili risk faktörleri lojistik regresyon analizi ile değerlendirilmiştir. BULGULAR: Hastaların %50,8'i kadındı; ortalama yaş 72,5±7,0 yıldı. En sık görülen semptomlar dizüri (%65,3), anoreksi (%65,3) ve yan ağrısı (%57,6) idi. En sık izole edilen patojen Escherichia coli (%29,4) olmuştur. Olguların 49’u (%41,5) nozokomiyal idrar yolu enfeksiyonu idi. Tüm nedenlere bağlı hastane içi mortalite 48 hastada (%40,6) gözlenirken, 22 hastada (%18,6) doğrudan idrar yolu enfeksiyonu ile ilişkili hastane içi mortalite görülmüştür. Ürosepsis (odds ratio (OR):13.518, %95 CI: 1.711-106.793, p=0.014), böbrek taşı (OR:7.529, %95 CI: 1.596-35.525, p=0.011) ve çok ilaca dirençli organizmaların neden olduğu idrar yolu enfeksiyonları (OR: 18.612, %95 CI: 1.564-4.283, p<0.001) mortalite için bağımsız risk faktörleri, uygun tedavinin (OR: 0.090, %95 CI: -3.736--1.085, p<0.001) mortalite için bağımsız bir koruyucu faktör olduğu bulunmuştur. SONUÇ: Yaşlı yetişkinlerde idrar yolu enfeksiyonları çok çeşitli semptomlarla ortaya çıkar ve ağırlıklı olarak ilaca dirençli Escherichia coli'den kaynaklanır. Ürosepsis ve böbrek taşları mortalitenin kritik belirleyicileridir ve hızlı ve uygun yönetim stratejilerine duyulan ihtiyacı vurgular. Yaşlı yetişkinlerde idrar yolu enfeksiyonlarının etiyolojisi, klinik özellikleri ve mortalite risk faktörlerinin bilinmesi, bu hassas popülasyonda enfeksiyon yönetimini optimize etmek için çok önemlidir.

Anahtar Kelimeler

• İdrar yolu enfeksiyonu
• Yaşlı
• Etiyoloji
• Direnç
• Mortalite.

DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS

Öz

OBJECTIVE: Urinary tract infections are common in older adults and associated with significant morbidity and mortality. This study aimed to characterize the clinical features, bacterial etiologies, antimicrobial resistance patterns, and risk factors for mortality in elderly patients hospitalized with urinary tract infection. MATERIAL AND METHODS: Data were retrospectively analyzed from 118 patients aged ≥65 years hospitalized with a diagnosis of urinary tract infection between January 2018 and December 2022. Urinary tract infections were defined according to Centers for Disease Control and Prevention criteria. Isolated microorganisms in urine cultures and antimicrobial resistance rates were determined. Risk factors associated with mortality were evaluated by logistic regression analysis. RESULTS: 50.8% of patients were female; the mean age was 72.5±7.0 years. The most common symptoms were dysuria (65.3%), anorexia (65.3%), and flank pain (57.6%). Forty-nine patients (41.5%) had nosocomial urinary tract infections. All cause in hospital mortality was observed in 48 patients (40.6%), and 22 patients (18.6%) had in-hospital mortality directly related to urinary tract infection. Urosepsis (OR: 13.518, 95% CI: 1.711-106.793, p=0.014), kidney stones (OR: 7.529, 95% CI: 1.596-35.525, p=0.011) and urinary tract infections caused by multidrug-resistant organisms (OR: 18. 612, 95% CI: 1.564-4.283, p<0.001) were independent risk factors for mortality, and appropriate treatment (OR: 0.090, 95% CI: -3.736--1.085, p<0.001) was an independent protective factor for mortality. CONCLUSIONS: Urinary tract infections in elderly adults present with a wide range of symptoms and are predominantly caused by drug-resistant Escherichia coli. Urosepsis and kidney stones are critical determinants of mortality, emphasizing the need for rapid and appropriate management strategies. Understanding the etiology, clinical features, and mortality risk factors of urinary tract infections in elderly adults is crucial for optimizing infection management in this vulnerable population.

Anahtar Kelimeler

• Urinary tract infection
• Elderly
• Etiology
• Resistance
• Mortality.

Kaynakça

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