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Diagnostics
Volume 11
Issue 3
10.3390/diagnostics11030523
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Article

Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact

by
Caroline Laborde
1,
Julien Bador
2,
Arthur Hacquin
1,
Jérémy Barben
1,
Sophie Putot
1,
Patrick Manckoundia
1 and
Alain Putot
1,*
1
Médecine Interne Gériatrie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
2
Laboratoire de Microbiologie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
*
Author to whom correspondence should be addressed.
Diagnostics 2021, 11(3), 523; https://doi.org/10.3390/diagnostics11030523
Submission received: 17 February 2021 / Revised: 10 March 2021 / Accepted: 11 March 2021 / Published: 15 March 2021
(This article belongs to the Special Issue Urinary Tract Infections: Diagnosis and Management)
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Abstract

In older patients, urinary tract infection (UTI) often has an atypical clinical presentation, making its diagnosis difficult. We aimed to describe the clinical presentation in older inpatients with UTI-related bacteremia and to determine the prognostic impact of atypical presentation. This cohort study included all consecutive patients older than 75 years hospitalized in a university hospital in 2019 with a UTI-related gram-negative bacillus (GNB) bacteremia, defined by blood and urine cultures positive for the same GNB, and followed up for 90 days. Patients with typical symptoms of UTI were compared to patients with atypical forms. Among 3865 inpatients over 75 with GNB-positive urine culture over the inclusion period, 105 patients (2.7%) with bacteremic UTI were included (mean age 85.3 ± 5.9, 61.9% female). Among them, UTI symptoms were reported in only 38 patients (36.2%) and 44 patients (41.9%) had no fever on initial management. Initial diagnosis of UTI was made in only 58% of patient. Mortality at 90 days was 23.6%. After adjustment for confounders, hyperthermia (HR = 0.37; IC95 (0.14–0.97)) and early UTI diagnosis (HR = 0.35; IC95 (0.13–0.94)) were associated with lower mortality, while UTI symptoms were not associated with prognosis. In conclusion, only one third of older patients with UTI developing bacteremia had UTI symptoms. However, early UTI diagnosis was associated with better survival.
Keywords: urinary tract infection; aged; bacteremia; symptoms; fever; mortality; atypical presentation; bacteriuria; immunosenescence urinary tract infection; aged; bacteremia; symptoms; fever; mortality; atypical presentation; bacteriuria; immunosenescence

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MDPI and ACS Style

Laborde, C.; Bador, J.; Hacquin, A.; Barben, J.; Putot, S.; Manckoundia, P.; Putot, A. Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact. Diagnostics 2021, 11, 523. https://doi.org/10.3390/diagnostics11030523

AMA Style

Laborde C, Bador J, Hacquin A, Barben J, Putot S, Manckoundia P, Putot A. Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact. Diagnostics. 2021; 11(3):523. https://doi.org/10.3390/diagnostics11030523

Chicago/Turabian Style

Laborde, Caroline, Julien Bador, Arthur Hacquin, Jérémy Barben, Sophie Putot, Patrick Manckoundia, and Alain Putot. 2021. "Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact" Diagnostics 11, no. 3: 523. https://doi.org/10.3390/diagnostics11030523

APA Style

Laborde, C., Bador, J., Hacquin, A., Barben, J., Putot, S., Manckoundia, P., & Putot, A. (2021). Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact. Diagnostics, 11(3), 523. https://doi.org/10.3390/diagnostics11030523

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