Introduction:

Urinary  tract infection is defined as a disease caused by microbial invasion of the genitourinary tract that extends from renal cortex of kidney to the urethral meatus. Normally, kidneys, ureters, urinary bladder and proximal urethra are sterile but bacteria may be present in distal urethra as transient flora, most of which are derived from faecal flora. Gram negative bacilli are by far the most common infecting agents. E.coli is the commonest gram negative organism producing UTI. Staphylococcus aureus is the commonest gram positive organism producing UTI. Candida albicans may produce UTI in Diabetics and immuno compromised patients.

Geriatrics or elderly or Senior citizen is defined as a person with chronological age of 65 years. Urinary tract infection is very common in the elderly and presents a series of problems. The diagnosis of urinary tract infection is usually determined by  quantitative cultures of clean catch midstream urine specimens. Cultures with 105 bacteria per ml. has an 80% propability of indicating infection. Two urine cultures ,each demonstrating titres of 3×105 /ml of the same bacteria have a propability of 95% of indicating urinary tract infection. 

This study will be aiming at identifying the prevalence of UTI in Geriatric bed ridden patients above 65 yrs of age admitted in hospital for varied illnesses. The normal ambulant patients above 65 yrs attending OPD for some other ailment will act as controls.

Inclusion criteria for the study are

  1. Males and females above 65 yrs. of age and bedridden in hospitals
  2. Patients may or may not be with symptoms of UTI
  3. May or may not be with catheters.
  4. If catheterised, the period of catheter should not be more than 48 hrs.

Exclusion criteria are 

      1. Below 65 yrs age

      2. Normal ambulant patients

      3. Period of catheter more than 48 hrs

The sample size is 300 cases and 300 controls and the period of study will be 3 months and the places of study will be in nursing homes  at Perambur and KVR Nagar  Chennai .

Aims and Objectives:

  1. To know the common geriatric age group  and sex involved  in UTIs of bedridden Geriatrics.
  2. To know the incidence of  symptomatic and asymptomatic UTIs in bedridden geriatrics.
  3. To know whether the bacterial counts in bedridden geriatrics are significant or not.
  4. To know whether the UTIs in bedridden  geriatrics are due to single organism or polymicrobial.
  5. To know the common factors involved in bedridden geriatrics for UTI. 

Materials and Methods:

A total of 50 bedridden patients above 65 yrs. of age with varied illnesses and with or without symptoms of urinary tract infection and with less than 48 hr catheter or without catheter will be selected for this study. Urine sample will be collected from these patients aseptically after cleaning the external genitalia with skin antiseptics. The samples will be transported to the laboratory within 2 hrs. The urine sample will be selected for streaking over culture plates by examining the number of pus cells. The culture plates selected will be Nutrient agar and MacConkey plates. The plates will be incubated overnight in the incubator and viewed for colonies after 24 hrs. The colony count is determined and the samples showing more than 105   organisms /ml  will be considered as significant bacteriuria. The plates will be examined whether it shows single organism or multiple organisms, The name of organisms are identified by the biochemical tests. The patients will be enquired for any symptoms of UTI and it will be noted. The results will be tabulated and analysed statistically.

Results:

Table 1-Age and sexwise  distribution of UTIs in bedridden

                                                                                                         N=50

Sl.noAge groupNo.present%Males(%)Females(%)
165-70



271-75



376-80



4Above  80



Table -2- Incidence of symptomatics and non symptomatic

Sl.noSymptomsNos. and % present in casesNos and % present in controls
1Dysuria

2Pain abdomen

3Fever with rigor

4No symptoms

Fig.3 -Incidence of significant and insignificant bacteriuria in cases and controls

Fig.4- Incidence of uni and polymicrobials in cases and control

The results will be analysed by the software system MS Excel.

——-     Dr.Keerthana Victoria