The importance of
urinary tract infection in elderly populations and some of the unique features in its evaluation and
therapy are becoming better recognized. In elderly populations in the community there are concerns about increasing antimicrobial resistance in infecting organisms. In postmenopausal women, the importance of vaginal
estrogen deficiency as
a factor which promotes
urinary tract infection is becoming increasingly recognized, leading to therapeutic strategies other than antimicrobials. For elderly residents of
long term care facilities,
urinary tract infection is very common, and most frequent in those with the greatest functional impairment. Whilst it is recognized that asymptomatic
bacteriuria should not be treated, the diagnosis of
urinary tract infection in this population often presents a dilemma. In particular, the urine culture is useful only in excluding
urinary tract infection, not in making a diagnosis of symptomatic
infection. There has been a tendency to manage all
clinical deterioration in
long term care facility residents who have positive urine cultures as
urinary tract infection, contributing to excess antimicrobial use and heightening the problem of antimicrobial resistance. Recently published guidelines and commentaries attempt to address this problem.