Urinary tract infection in the elderly: a clinical study.

Urinary tract infection is one of the most common causes of infection in the elderly living in the community as well as in institutions. While the preventive measures involve the enhancement of immunological status, perineal hygiene and avoiding unnecessary instrumentation, the clinical manifestation predicting the outcome, the main objective of the study, is also no less important after the infection takes place. Cross-sectional study was designed recruiting 107 cases from the general medical wards to compare various relevant clinical parameters in terms of the final outcome. The result showed that the aged group 75 years old or more, the catheter-related cases, prior bedbound status, confusion, anorexia with nasogastric tube feeding, respiratory failure requiring mechanical ventilation, septic shock, the presence of candida in urine, the extreme temperature either less than 37 degrees C or more than 40 degrees C and finally the mistake in interpreting the gram stain of the urine were found more common in the dead group with statistical significance. Multiple logistic regression analysis revealed anorexia with nasogastric tube feeding, prior bedbound status, the need for mechanical ventilation, septic shock and extreme body temperature response independently predicted the outcome of the elderly with urinary tract infection.

Serogroup distribution and antimicrobial susceptibility of beta-hemolytic streptococci in clinical isolates.

Three hundred and four strains of beta-hemolytic streptococci were isolated from different patients at Siriraj Hospital during 1989-1990. Among these strains, 24.01% were group A, 23.03% were group B, 2.96% were group C, 29.61% were group D, 0.66% were group F, 6.25% were group G and 13.48% could not be grouped by using the Lancefield reference method. The distribution of each serogroup according to the types of clinical specimens was also studied. From pus, group A Streptococcus (44.8%) was the most frequent isolate. From vagina/cervix/urethra specimens, group B Streptococcus (47.95%) was the most frequent isolate. From urine, group D Streptococcus (82.5%) was the most frequent isolate. From blood, group B Streptococcus (43.33%) was the most frequent isolate. From throat/sputum specimens, only group A Streptococcus was isolated. There were some differences in susceptibility to 19 antimicrobial agents among various groups of streptococci. Resistance to penicillin was not found in groups A, B, C, F and G streptococci except for group D (91.1% resistance for enterococci and 33.3% resistance for non-enterococci) and nongroupable streptococci (12.2% resistance).