The old bedridden patients, especially in combination with the sequelae of cerebrovascular disorders, are frequently suffered from urinary tract infections (UTI). This paper reviews the clinical microbiological study on UTI of the aged. 638 mean aged 75 yr bedridden patients (159 male, 479 female), who admitted to Koseiso Hospital, Tama Institute for Adult Diseases, between 1974 and 1979, because of the sequelae of cerebrovascular disorders were studied for the purpose of observing annual incidence of microorganisms. Samples for quantitative culture examinations were obtained by urinary catheter, and in some female cases, vaginal microbilological examinations were also performed. Results were as follows:
1) A total of 1901 strains of microorganisms were isolated from 1267 cultures during six years observation. The most important infecting organisms were
Staph. aureus, E. coli, Klebsiella, indole positive
Proteus groups. Comparing the annual frequency of the organisms, there was the decrease in the proportion of Staph.aureus, Klebsiella, Pr.mirabilis in the year from 1976 to 1979, whereas
E. coli, indole positive
Proteus groups and
Ps. aeruginosa were increasing year by year, especially very striking was the rise of the percentage of indole positive
Proteus groups, which were found in 18% of samples during 1974, in 26% during 1975, in 39% during 1978, and in 34% during 1979. Another interesting features is that very often mixed infections with these organisms were observed.
2) In annual change of antimicrobial susceptibilities against commonly used antimicrobials to the isolates, the rise in frequency of antimicrobial resistant strains was observed year by year, especially in the predominant isolates of
Proteus groups.
3) Among 56 cases of UTI, 8 cases (14.3%) presented a change of the original bacteria after a course of antibacterial treatment.
4) A total of 25 vaginal specimens were collected from female bedridden patients. In vaginal cultures, numorous species were recovered. Many of them were gram negative rods, but other bacteria of low pathogenicity, so called “opportunistic pathogens” such as glucose nonfermentative gram negative rods, anaerobes and fungi, were also isolated.
These results indicated that many cases of UTI of the aged were complicated type of infection and sometimes took longterm course with change of spectrum of bacteria, and was often in combination with mixed infection due to resistant type of oragnisms. These facts represent a serious problem in antimicrobial chemotherapy. Effective chemotherapy, of course, seems to be essential condition for a treatment of these infections. In addition to this, good nursing care, maintenance of hygine including urinary bladder and vagina are also important measures for prevention and treatment for these types of UTI.
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