[Urinary tract infections in internal medicine]

Abstract

Objectives: Analysis of characteristics of patients in internal medicine (IM) hospital wards in Spain with the diagnosis of urinary tract infection (UTI).

Patients and methods: Observational, descriptive, retrospective study of a population of inpatients with UTI diagnosis (October-December, 2007). Recorded variables included personal data, risk factors for complicated UTI, diagnosis criteria, microbiological results and antibiotics used.

Results: A total of 992 patients (61.8% women), from 57 hospitals, were recruited. Mean age was 75.3 years old (SD 16.5), with 18.1% from nursing homes and with some physical dependence in 53.5%. The majority (78.3 %) had some risk factors (diabetes mellitus 33.6%, vesical catheterization 24.1%). Non-specific UTI was the most frequent diagnosis (38.1%). UTI was diagnosed in 46%, based exclusively on urinary sediment alterations and/or positive cultures. E. coli was the most frequent pathogen (64.17%), with intermediate sensitivity or resistance of 22.8% to amoxicillin-clavunanic, 34.8% to levofloxacin and 40.6% to ciprofloxacin. Amoxicillin-clavulanic was the most used antibiotic (30.9%). UTI delayed hospital discharge in a 13.3%. Intrahospital-UTI was statistically more frequent (23%) with vesical catheterization (50.5 vs 16.2%) and mortality (3.4%) in older patients (81.2 vs. 75.1 years old.), in patients with P. aeruginosa cultures (11.8 vs 4.1%) and in those with urinary sepsis (41.4 vs 16.2%).

Conclusions: Patients in internal medicine wards with a UTI diagnosis are older and with risk factors. Frequently, UTI is diagnosed based on non-specific criteria. E. coli is the most frequent pathogen. Quinolones should not be the first-line treatment in complicated or severe UTI, due to the high percentages of resistance.