Urinary tract infection at the age extremes: pediatrics and geriatrics

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Abstract

Urinary tract infections (UTIs) are common and generally benign conditions among healthy, sexually active young women without long-term medical sequelae. In contrast, UTIs are more complicated among those individuals at either end of the age spectrum: infants/young children and geriatrics. UTI in children younger than 2 years has been associated with significant morbidity and long-term medical consequences, necessitating an extensive and somewhat invasive imaging evaluation to identify possible underlying functional or anatomic abnormalities. Pediatric UTI should be considered complicated until proved otherwise, and treatment should reflect the severity of signs and symptoms. Management in the acutely ill child frequently involves parenteral broad-spectrum antimicrobial agents, and less ill children can be treated with trimethoprim- sulfamethoxazole (TMP-SMX), β-lactams, and cephalosporins.

UTI among older patients (>65 years) may be complicated by comorbidities, the baseline presence of asymptomatic bacteriuria, and benign urinary symptoms that can complicate diagnosis. The etiology of UTI encompasses a broader spectrum of infecting organisms than is seen among younger patients and includes more gram-positive organisms. Symptomatic UTI is generally more difficult to treat than among younger populations. Management should be conservative, of longer treatment durations, and cover a broad spectrum of possible uropathogens. Oral or parenteral treatment with a fluoroquinolone for 7 days is the preferred empiric approach. TMP-SMX can also be considered a first-line agent in women only, but only if the pathogen is known to be TMP-SMX sensitive.

Section snippets

Pediatric patients

There are important differences in the clinical course, medical sequelae, and diagnostic and management approaches of UTIs between infants and pediatric patients and adults. Unlike the generally benign nature of UTI among young women, UTI in pediatric populations is associated with significantly greater morbidity and long-term consequences, such as impaired renal function, hypertension, end-stage renal disease, and complications of pregnancy as an adult. In children with risk factors, recurrent

Geriatric patients

The diagnosis and management of UTI among elderly persons can be particularly challenging to the clinician because of substantial differences between geriatric and otherwise healthy younger adults (Table 6). Geriatric patients with UTI frequently have an atypical clinical presentation, a higher prevalence of comorbidities, and an increased risk of drug-drug and disease-disease interactions. As such, the majority of presumably “uncomplicated” UTIs among the elderly would be characterized as

Conclusion

UTIs are common across all ages and are consistently more prevalent among females than males across almost all generations. The greatest incidence of acute, community-acquired uncomplicated UTI is found among young sexually active women. Such infections are benign conditions with no long-term medical sequelae. In comparison, UTIs that occur in the very young patient can have significant and severe long-term ramifications, including renal scarring and end-stage renal disease. As such, the

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