Urinary tract infection in patients with hip fracture: An underestimated event?

Nurse-Driven Process for the Successful Removal of Urinary Catheters Among Elderly Patients After Hip Fracture Surgery: A Quality Improvement Project

BACKGROUND

Hip fracture is a major health concern and the use of an indwelling urinary catheter (IUC) constitutes a significant burden on elderly patients undergoing hip fracture surgery.

LOCAL PROBLEM

The institution had a high rate of urinary tract infection (UTI) and IUC reinsertion after hip fracture surgery.

METHODS

A pre/post-implementation design was used for this quality improvement initiative.

INTERVENTIONS

A nurse-driven process was developed and implemented to improve the successful removal of IUC among patients after hip fracture surgery.

RESULTS

There was a significant reduction in post-operative urinary retention ( P = .042), UTI rate ( P = .047), and IUC reinsertion ( P = .042) in the post-implementation group. IUC duration decreased by 1.1 days, however this was not significant ( P = .206). Nurse compliance with following the new process was 93.3%.

CONCLUSION

The nurse-driven process designed for elderly patients following hip fracture surgery presents a promising approach to reducing IUC reinsertion rates and UTI.

Key Considerations for Frail Patients Undergoing Hip Fracture Surgery

Improving preoperative care for elderly patients with hip fractures is crucial for achieving the best outcomes. A multidisciplinary team that can improve overall care quality by addressing patient's medical conditions, analgesia, timely surgery, and early postoperative mobilization is required. This narrative review provides insights regarding the extent of preoperative optimization needed for hip fracture surgery.

Glucose-albumin ratio (GAR) as a novel biomarker of postoperative urinary tract infection in elderly hip fracture patients

Purpose

Postoperative urinary tract infections (UTIs) worsen the prognosis of elderly patients with hip fractures. This study aimed to assess the predictive ability of blood-based biomarkers, specifically the glucose-albumin ratio (GAR), in predicting postoperative UTIs.

Methods

A retrospective observational study of 1,231 patients from a Level I trauma center was conducted. We evaluated the prognostic and predictive value of 15 biomarkers, including the glucose-albumin ratio, in elderly patients with hip fractures. The primary outcome measure was the incidence of postoperative UTIs.

Results

The glucose to albumin ratio transformed into GAR was superior to any other biomarker in predicting postoperative UTIs in elderly hip fracture patients (AUC = 0.756, p < 0.001). Elevated GAR (using the best cut-off value of 0.18) was independently associated with postoperative UTIs (OR 3.20, 95% CI 2.23-4.58). Further analysis dividing GAR levels into four groups according to quartiles showed that compared to patients with GAR levels of Q1 (< 0.14), GAR levels of Q2 (0.14-0.17; OR 2.11, 95% CI 1.07-4.15), Q3 (0.17-0.21; OR 3.36, 95% CI 1.74-6.52) and Q4 (> 0.21; OR 7.55, 95% CI 3.84-14.83) patients had significantly higher odds of UTIs.

Conclusion

GAR holds potential as a novel biomarker for predicting postoperative UTIs in elderly patients with hip fractures.

Surgical management and outcomes following atypical subtrochanteric femoral fractures - results from a matched-pair analysis of the registry for geriatric trauma of the German Trauma Society

BACKGROUND AND OBJECTIVES

The outcomes of patients with atypical subtrochanteric fractures (ASFs) remain unclear. Data from a large international geriatric trauma registry were analysed to examine the outcome of patients with ASFs compared to patients with typical osteoporotic subtrochanteric fractures (TSFs).

MATERIALS AND METHODS

Data from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analysed. All patients treated surgically for ASFs or TSFs were included in this analysis. Across both fracture types, a paired matching approach was conducted, where statistical twins were formed based on background characteristics sex, age, American Society of Anesthesiologists (ASA) score and walking ability. In-house mortality and mortality rates at the 120-day follow-up, as well as mobility at 7 and 120 days, the reoperation rate, hospital discharge management, the hospital readmission rate at the 120-day follow-up, health-related quality of life, type of surgical treatment and anti-osteoporotic therapy at 7 and 120 days, were assessed as outcome measures using a multivariate logistic regression analysis.

RESULTS

Amongst the 1,800 included patients, 1,781 had TSFs and 19 had ASFs. Logistic regression analysis revealed that patients with ASFs were more often treated with closed intramedullary nailing (RR = 3.59, p < 0.001) and had a higher probability of vitamin D supplementation as osteoporosis therapy at 120 days (RR = 0.88, p < 0.002). Patients with ASFs were also more likely to live at home after surgery (RR = 1.43, p < 0.001), and they also tended to continue living at home more often than patients with TSFs (RR = 1.33, p < 0.001). Accordingly, patients with TSFs had a higher relative risk of losing their self-sufficient living status, as indicated by increased rates of patients living at home preoperatively and being discharged to nursing homes (RR = 0.19, p < 0.001) or other hospitals (RR = 0.00, p < 0.001) postoperatively.

CONCLUSIONS

Surgical treatment of ASFs was marked by more frequent use of closed intramedullary fracture reduction. Furthermore, patients with ASFs were more likely to be discharged home and died significantly less often in the given timeframe. The rate of perioperative complications, as indicated by nonsignificant reoperation rates, as well as patient walking abilities during the follow-up period, remained unaffected.

Common hematological and biochemical parameters for predicting urinary tract infections in geriatric patients with hip fractures

Background

This study aims to discern the significance of common hematological and biochemical parameters for predicting urinary tract infections in geriatric patients with hip fractures.

Methods

Multivariable logistic regression and propensity score-matched analyses were conducted to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for UTIs. The abilities of these parameters to predict UTIs were evaluated by receiver operating characteristic (ROC) curves. Dose-response relationships were assessed by categorizing hematological and biochemical parameters into quartiles. Subgroup analyses were further explored to investigate the relationship between these parameters and urinary tract infections.

Results

Out of the 1,231 participants, 23.2% were diagnosed with UTIs. Hyperglycemia, hypoproteinemia and hyperglobulinemia were risk factors for UTIs in multivariate analysis. After propensity score matching, hyperglycemia (OR 2.14, 95% CI 1.50-3.05, p < 0.001), hypoproteinemia (OR 1.75, 95% CI 1.18-2.63, p = 0.006), and hyperglobulinemia (OR 1.38, 95% CI 0.97-1.97, p = 0.074) remained significantly associated with increased odds of urinary tract infections. ROC curve analyses showed moderate predictive accuracy of blood glucose, albumin and globulin for UTIs, with areas under the curves of 0.714, 0.633, and 0.596, respectively. Significant dose-response relationships were observed between these parameters and UTIs. The associations were consistent in subgroup analyses.

Conclusion

Blood glucose, albumin and globulin levels can facilitate early identification of geriatric hip fracture patients at high risk of UTIs. These easily obtainable hematological and biochemical parameters provide a practical clinical prediction tool for individualized UTI prevention in this population.

Influence of urinary tract infections on the incidence of surgical site infections following hip fracture surgery: A systematic review and meta-analysis

The prevalence of surgical site infections (SSIs) following hip fracture surgery poses a substantial challenge, compounding patient morbidity and healthcare costs. This systematic review and meta-analysis investigate the potential correlation between perioperative urinary tract infections (UTIs) and the subsequent risk of SSIs, aiming to illuminate the impact of UTIs on postoperative outcomes in this vulnerable population. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilising the PICO framework to define our search strategy across PubMed, Embase, Web of Science and the Cochrane Library. Our inclusion criteria encompassed randomised controlled trials, cohort studies and case-control studies that reported on SSIs following hip fracture surgery in patients with UTIs. Quality was assessed using the Newcastle-Ottawa Scale, and heterogeneity was quantified using the I2 statistic. A random-effects model was applied due to significant heterogeneity, and a sensitivity analysis assessed the stability of the results. Six studies met the inclusion criteria, demonstrating high methodological quality. The analysis included studies from 2016 to 2021, with sample sizes ranging from 402 to 31 621 participants. A significant association was found between UTIs and SSIs, with an odds ratio of 2.79 (95% CI: 1.72-4.54, p < 0.001). Sensitivity analysis confirmed the robustness of the results, and no publication bias was detected. Perioperative UTIs significantly increase the risk of SSIs in patients undergoing hip fracture surgery. Proactive treatment of UTIs may be crucial for reducing the incidence of SSIs and improving surgical outcomes in this demographic.

Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis

Background

Urinary tract infection (UTI) is a prevalent and consequential complication in hip fracture patients, leading to significant disability and heightened healthcare expenditures. Consequently, there is a critical need for a comprehensive systematic review to identify risk factors and establish early and effective preventive measures.

Methods

A comprehensive search was performed across the PubMed, Cochrane, Embase, Web of Science, and Scopus databases (up to August 31, 2023). Article screening, data extraction, and quality assessment were independently completed by two reviewers.

Results

Forty-four studies were eligible for inclusion, yielding an overall incidence rate of 11% (95% CI: 8%-14%). Our pooled analysis revealed 18 significant risk factors, including being female (OR = 2.23, 95% CI: 1.89-2.63), advanced age (MD = 1.35, 95% CI: 0.04-2.66), obesity (OR = 1.21, 95% CI: 1.11-1.31), catheterization (OR = 3.8, 95% CI: 2.29-6.32), blood transfusion (OR = 1.39, 95% CI: 1.21-1.58), American Society of Anesthesiologists ≥III (OR = 1.28, 95% CI: 1.18-1.40), general anesthesia (OR = 1.26, 95% CI: 1.11-1.43), intertrochanteric fracture (OR = 1.25, 95% CI: 1.01-1.54), hemiarthroplasty (OR = 1.43, 95% CI: 1.19-1.69), prolonged length of hospital stay (MD = 1.44, 95% CI: 0.66-2.23), delirium (OR = 2.66, 95% CI: 2.05-3.47), dementia (OR = 1.82, 95% CI: 1.62-2.06), Parkinson's disease (OR = 1.53, 95% CI: 1.46-1.61), diabetes (OR = 1.27, 95% CI: 1.13-1.43), hypertension (OR = 1.14, 95% CI: 1.03-1.26), congestive heart failure (OR = 1.35, 95% CI: 1.10-1.66), history of sepsis (OR = 7.13, 95% CI: 5.51-9.22), and chronic steroid use (OR = 1.29, 95% CI: 1.06-1.57).

Conclusion

Our study identifies numerous risk factors strongly associated with UTI, offering compelling evidence and actionable strategies for improving clinical prediction, enabling early intervention, and facilitating targeted UTI management.

Systematic review registration

identifier [CRD42023459600], https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600.

Correlation between admission hypoalbuminemia and postoperative urinary tract infections in elderly hip fracture patients

PURPOSE

This study aimed to evaluate the correlation between hypoalbuminemia upon admission and the incidence of postoperative urinary tract infections (UTIs) in elderly patients with hip fractures.

METHODS

A retrospective analysis was performed on the medical records of elderly patients who underwent surgical treatment for hip fractures at a level I trauma center from 2013 to 2023. Serum albumin levels were measured upon admission, and hypoalbuminemia was defined as a total albumin level < 35 g/L. Multivariable logistic regression and propensity score matching analysis were utilized to control and reduce potential confounding factors, aiming to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CI) for UTIs to determine the strength of the association.

RESULTS

This observational cohort study included 1279 patients, among whom 298 (23.3%) developed UTIs. Patients with albumin levels < 35 g/L had significantly greater odds of developing UTIs compared to those with albumin levels ≥ 35 g/L (OR 1.86, 95% CI 1.28-2.70). Further analysis, dividing albumin levels into quartiles, demonstrated that patients in the Q2 group (38.0-40.9 g/L; OR 1.38, 95% CI 0.88-2.17), Q3 group (35.0-37.9 g/L; OR 1.69, 95% CI 1.06-2.71), and Q4 group (15.3-34.9 g/L; OR 2.67, 95% CI 1.61-4.43) had notably higher odds of developing UTIs compared to those in the Q1 group (41.0-52.0 g/L).

CONCLUSIONS

The presence of hypoalbuminemia upon admission in elderly patients undergoing hip fracture surgery is strongly correlated with the occurrence of postoperative UTIs. Furthermore, this association exhibits a clear dose-response relationship.

The relationship between admission hyperglycaemia and urinary tract infections in geriatric patients with hip fractures

PURPOSE

This study investigated the association of admission hyperglycaemia with catheter-associated urinary tract infections (CAUTIs) and catheter-unassociated urinary tract infections (CUUTIs) in elderly patients with hip fractures.

METHODS

In an observational cohort study of elderly patients with hip fractures, glucose values were collected within 24 h of admission. Urinary tract infections were classified as CAUTIs and CUUTIs. Multivariate logistic regression analysis and propensity score matching obtained adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for urinary tract infections. Subgroup analyses were further explored to investigate the relationship between admission hyperglycemia and urinary tract infections.

RESULTS

The study included 1279 elderly patients with hip fractures, 298 (23.3%) of whom had urinary tract infections upon hospitalization (including 182 CAUTIs and 116 CUUTIs). Propensity score matching indicated that patients with glucose levels exceeding 10.00 mmol/L had significantly higher odds of developing CAUTIs (OR 3.10, 95% CI 1.65-5.82) than those with glucose levels between 4.00-6.09 mmol/L. It is worth noting that patients with blood glucose levels greater than 10.00 mmol/L have a higher susceptibility for CUUTIs (OR 4.42, 95% CI 2.09-9.33) than CAUTIs. The subgroup analyses observed significant interactions between diabetes and CAUTIs (p for interaction = 0.01) and between bedridden time and CUUTIs (p for interaction = 0.04).

CONCLUSIONS

Elderly hip fracture patients with admission hyperglycaemia have an independent association with CAUTIs and CUUTIs. The association is stronger with CUUTIs and necessitates clinician intervention if blood glucose levels at admission exceed 10 mmol/L.

Urinary tract infection is associated with 2.4-fold increased risk of surgical site infection in hip fracture surgery: systematic review and meta-analysis

BACKGROUND

There is no consensus regarding whether urinary tract infection (UTI) should be screened for or treated in hip fracture patients.

AIM

To assess the relationship between perioperative UTI and surgical site infection (SSI) in hip fracture patients, and the relationship between urinary catheterization and SSI in these patients.

METHODS

PubMed, Embase, CINAHL and Cochrane Library were searched to identify studies that evaluated the relationship between perioperative UTI and SSI and/or between urinary catheterization and SSI. Articles were included if they used the term UTI or specified UTI as symptomatic bacteriuria.

FINDINGS

A total of 4139 records were identified, with eight studies included. Meta-analysis of seven studies which evaluated perioperative UTI and SSI showed an SSI rate of 7.1% (95% confidence interval (CI): 3.8-13.2) among 1217 patients with UTI vs 2.4% (95% CI: 1.0-5.7) in 36,514 patients without UTI (OR: 2.41; 95% CI: 1.67-3.46; P < 0.001). In three studies which specifically defined UTI as symptomatic bacteriuria, the SSI rate among UTI patients was 5.7% (95% CI: 4.0-8.1) vs 1.1% (95% CI: 0.2-5.2) in those without UTI (OR: 3.00; 95% CI: 0.55-16.26; P = 0.20). One study evaluated urinary catheterization and SSI.

CONCLUSION

Perioperative UTI is associated with a higher risk of SSI among hip fracture patients but the evidence is limited by the heterogeneity in the definition of UTI. We recommend considering the possibility of perioperative UTI in hip fracture patients, with treatment administered as necessary to reduce SSI rates.

Incidence and risk factors for surgical site infection (SSI) after primary hip hemiarthroplasty: an analysis of the ACS-NSQIP hip fracture procedure targeted database

INTRODUCTION

Primary hip hemiarthroplasty (HHA) is frequently utilized to treat geriatric hip fractures, which are associated with significantly higher morbidity and mortality. While not particularly common, surgical site infection (SSI) is a major complication that frequently requires revision surgery in a frail population. The objective of this study was to determine the incidence of and risk factors for SSI after HHA in hip fracture patients.

MATERIALS AND METHODS

This retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Geriatric patients (65+) who underwent HHA for non-pathologic, traumatic hip fractures between 2016-2017 were included. Demographic variables, comorbidities, operative variables, and complications were compared between "SSI" and "non-SSI" groups. Multivariate regression identified independent risk factors for postoperative SSI. Significance was set at P = 0.05.

RESULTS

A total of 6169 patients were included. The overall incidence of SSI was 1.3%. SSI was significantly associated with body mass index (BMI), preoperative functional status, congestive heart failure, chronic corticosteroid use, intraoperative time, sepsis, wound dehiscence, readmission within 30-days, and reoperation. On multivariate analysis, chronic steroid use (OR: 2.30, 95% CI: 1.13-4.70), BMI ≥ 35 kg/m² (OR: 3.59, 95% CI: 1.57-8.18), and intraoperative time ≥120 mins (OR: 2.15, 95% CI: 1.08-4.27) were found to be independent risk factors.

CONCLUSIONS

Postoperative SSI is a serious complication that is responsible for prolonged hospital stays, increased mortality, and greater healthcare costs. Here, we identified multiple risk factors for SSI after primary HHA in the US elderly population.

Measurement of Mobility and Physical Function in Patients Hospitalized With Hip Fracture: A Systematic Review of Instruments and Their Measurement Properties

OBJECTIVE

Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting.

METHODS

Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist.

RESULTS

Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness over time (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility.

CONCLUSION

Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting.

IMPACT

This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes.

Surgical treatment for fragility hip fractures during the COVID-19 pandemic resulted in lower short-term postoperative functional outcome and a higher complication rate compared to the pre-pandemic period

The COVID-19 pandemic adversely affected the functional outcomes of fragility hip fracture patients. This study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among patients treated during the pandemic. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods.

INTRODUCTION

This study aims to investigate the in-hospital complication rate and short-term postoperative functional outcomes of fragility hip fracture (FHF) patients compared between during the COVID-19 pandemic and the same 14-month time period 1 year prior to the pandemic.

METHODS

Using data from the Siriraj Fracture Liaison Service registry, FHF patients treated during the COVID-19 pandemic (1 March 2020 to 30 April 2021) were time-matched with FHF patients treated during the pre-pandemic period (1 March 2018 to 30 April 2019). We collected the rate of in-hospital postoperative complications and the postoperative functional outcomes at discharge and 3 months as measured by the Barthel Index (BI) and EuroQol visual analog scale (EQ-VAS). Functional outcome measures were compared between the pre-pandemic and pandemic periods.

RESULTS

There were 197 and 287 patients in the pre-pandemic and pandemic groups, respectively. At the 3-month postoperative follow-up, the mean postoperative BI score and change in BI score were both significantly lower in the pandemic group indicating poorer postoperative function. Moreover, FHF patients treated during the pandemic had significantly more in-hospital complications (36.6% vs. 22.8%, p = 0.002). There was no significant difference in the 3-month EQ-VAS or change in the EQ-VAS between groups.

CONCLUSION

The results of this study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among FHF patients treated during the COVID-19 pandemic compared to the pre-pandemic period. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods.

Incidence, risk factors and clinical implications of postoperative urinary tract infection in geriatric hip fractures

INTRODUCTION

Postoperative urinary tract infection (UTI) is common in geriatric patients; however, little is known about the impact of UTI in orthopedic trauma. The present study was designed to determine the risk factors and clinical impact of postoperative urinary tract infection (UTI) in acute geriatric hip fractures.

PATIENTS AND METHODS

Geriatric patients (≥65 years of age) undergoing hip fracture surgery were identified within the American College of Surgeons National Surgical Quality Improvement Program between 2016 and 2019. Patients presenting with UTI at the time of surgery were excluded. Baseline characteristics and outcomes were compared between patients with and without postoperative UTI. Multivariate logistic regression was performed, controlling for potential confounders.

RESULTS

A total of 46,263 patients included in the study. Overall, 1,397 (3.02%) patients had postoperative UTI. Patients who developed postoperative UTI had higher rates of pneumonia (6.44% vs. 3.76%, p < 0.001), DVT (2.22% vs. 1.04%, p < 0.001), sepsis (7.73% vs. 0.62%, p < 0.001), and more frequently experienced postoperative hospital lengths of stay exceeding 6 days (37.94% vs. 20.33%, p < 0.001). Hospital readmission occurred more frequently in patients with postoperative UTI (24.55% vs. 7.85%, p < 0.001), but surprisingly, these patients had a lower mortality rate (1.36% vs. 2.2%, p < 0.001). Adjusted analysis demonstrated the following variables associated with postoperative UTI: age ≥ 85 (OR = 1.37, 95%CI = 1.08 - 1.73), ASA class ≥ 3 (OR = 1.59, 95%CI = 1.21 - 2.08,), chronic steroid use (OR = 1.451, 95%CI = 1.05 - 1.89), blood transfusion (OR = 1.24, 95%CI = 1.05 - 1.48), and >2 days delay from admission to operation (OR = 1.37, 95%CI = 1.05 - 1.79). Postoperative UTI was significantly associated with sepsis (OR = 7.65, 95%CI = 5.72 - 10.21), postoperative length of stay >2 days (OR = 1.83, 95%CI = 1.07 - 3.13), and readmission (OR = 3, 95%CI = 2.54 - 3.55).

CONCLUSIONS

In our study, postoperative UTI was found in 3% of geriatric hip fracture patients. Predictors of postoperative UTI were age ≥ 85, ASA class ≥ 3, chronic steroid use, blood transfusion, and time to operation > 2 days from admission. Results showed that postoperative UTI is independently associated with sepsis, postoperative length of stay beyond 2 days, and hospital readmission. To diminish the risk of UTI and its consequences, we recommend operating geriatric hip fractures in 24-48 hours after admission.

Implementation of a Geriatrics-Focused Orthopaedic and Hospitalist Fracture Program Decreases Perioperative Complications and Improves Resource Utilization

OBJECTIVE

To evaluate whether the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program can improve perioperative outcomes and decrease resource utilization.

DESIGN

A retrospective chart review study was conducted before and after the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program, based on the American Geriatrics Society (AGS) AGS CoCare:Ortho.

SETTING

A large urban, academic tertiary center, located in the greater New York metropolitan area.

PARTICIPANTS

Patients 65 years and older hospitalized for operative hip fracture. Those with pathologic or periprosthetic fractures and chronic substance use were excluded.

MAIN OUTCOME MEASUREMENTS

Outcome measures included time to operating room (TtOR), length of stay, daily and total morphine milligram equivalents, use of preoperative transthoracic echocardiogram and blood transfusions, perioperative complications (eg, urinary tract infections), and 6-month mortality.

RESULTS

Our study included 290 patients hospitalized with hip fracture, before (N = 128) and after (N = 162) implementation. When compared with the preimplementation group, the postimplementation comanagement group had a lower TtOR (36.2 vs. 30.0 hours, P = 0.026) and hospital length of stay, decreased use of indwelling bladder catheters preoperatively and postoperatively (68.0% vs. 46.9%, P < 0.001, and 83.6 vs. 58.0%, P < 0.001, respectively), reduced daily opiate use (16.0 vs. 11.1 morphine milligram equivalents, P = 0.011), and decreased 30-day complications (32.8% vs. 16.7%, P = 0.002). There was no difference in 6-month mortality between the 2 groups.

CONCLUSIONS

The implementation of an AGS CoCare:Ortho-based comanagement program led to decreased perioperative complications and resource utilization. Comanagement programs are essential to improving and standardizing hip fracture care for older adults.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effectiveness of implementing a preventive urinary catheter care bundle in hip fracture patients

Background

Urinary catheter (UC)–associated infections are one of the most common preventable healthcare-associated infections (HAIs) and they frequently occur in older, frail populations.

Aim

The study aim was to describe the incidence of UC-associated infection in elderly patients undergoing hip fracture surgery after implementing a preventive care bundle.

Methods

A longitudinal prospective study using a before-and-after design. The bundle was theory driven and involved the co-creation of a standard operational procedure, education and practical training sessions. Prospectively collected registry data were analysed. Univariable statistics and multivariable logistic regressions were used for analyses.

Results

2,408 patients with an acute hip fracture were included into the study. There was an overall reduction in UC catheter associated-associated urinary tract infections, from 18.5% (n = 75/406) over time to 4.2% (n = 27/647). When adjusting for all identified confounders, patients in phase 4 were 74% less likely to contract an UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p < 0.0001).

Discussion

Bundled interventions can reduce UC-associated infections substantially, even in elderly frail patients. Partnership and co-creation as implementation strategies appear to be promising in the fight against HAI.

[EXPLORATORY EXAMINATION FOR THE FACTORS RELATED TO VOIDING DYSFUNCTION IN PATIENTS AFTER SURGERY FOR PROXIMAL FEMORAL FRACTURES]

(Purpose) While urinary retention and urinary tract infections accompanying residual urine are often experienced following proximal femoral fractures (femoral neck fractures and trochanteric fractures) in clinical practice, the pathology of the onset of voiding dysfunction for this disease is unclear since the nervous system associated with urination is not damaged due to the fracture not reaching the pelvis. Therefore, we exploratorily examined the factors related to voiding dysfunction in proximal femoral fractures. (Subjects and method) Among the patients who underwent surgery for proximal femoral fractures, we examined the relation between the proportion of cases in which withdrawing urine was required for residual urine after removing the urethral catheter and the differences in the fracture sites, pain, the ability to maintain a sitting position, the strength to bend the hip joints, and the volume of the iliopsoas muscle. (Results) The proportion of cases in which withdrawing urine was required was higher in the group suffering trochanteric fractures than the group suffering femoral neck fractures (41% vs. 11%), while the strength to bend the hip joints was lower. Regarding trochanteric fractures, compared to the group in which no urine was withdrawn, the group in which urine was withdrawn included more of the unstable type in which the fracture reached the lesser trochanter, which is the femoral insertion of the iliopsoas muscle (56% vs. 82%), in addition to having a significant decrease in the strength to bend the hip joints. Regarding trochanteric fractures, compared to the group without injury in lesser trochanter, the group with injury in lesser trochanter had a higher proportion of cases in which withdrawing urine was required (23% vs. 51%), in addition to the iliopsoas muscle thereof having been atrophied (-15.7% vs. -35.2%). (Conclusion) As factors related to voiding dysfunction following surgery for proximal femoral fractures, the relation between fracture sites, the strength to bend the hip joints associated with maintaining posture, the presence of injuries in the lesser trochanter, and the volume of the iliopsoas muscle were suggested. Therefore, it is possible that the proportion of cases in which the withdrawal of urine was required increased with the increase in residual urine due to the decrease in the ability to maintain a urinating posture until the bladder is completely empty.

Urinary Tract Infection in Parkinson's Disease

Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson's disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.

Hospital length of stay after hip fracture and its association with 4-month mortality - Exploring the role of patient characteristics

Background

Hospital length of stay (LoS) is believed to be associated with higher mortality in hip fracture patients; however, previous research has shown conflicting results. We aimed to explore the association between LoS and 4-month mortality in different groups of hip fracture patients.

Methods

The study population in this Swedish register-based cohort study was 47 811 patients 65 years or older with a first hip fracture during 2012–2016, followed up for 4 months after discharge. LoS was categorized by cubic splines, and the association between LoS and mortality was analyzed with Cox regression models, adjusted for sociodemographic- and health-related factors.

Results

Mean LoS was 11.2 ± 5.9 days and 12.3% of the patients died within 4 months. Both a shorter and a longer LoS, compared to the reference 9–12 days, were associated with higher mortality (hazard ratio [95% confidence interval]): 2–4 days 2.15 (1.98–2.34), 5–8 days 1.58 (1.47–1.69), and 24+ days 1.29 (1.13–1.46). However, in fully adjusted models, only the association with a long LoS remained: 13–23 days 1.08 (1.00–1.17) and 24+ days 1.42 (1.25–1.61). Stratifying by living arrangement revealed that the increased risk for a short LoS was driven by the group living in care homes. For patients living at home, a short LoS was associated with lower risk: 0.65 (0.47–0.91) and 0.85 (0.74–0.98) for 2–4 and 5–8 days, respectively.

Conclusions

A long LoS after a hip fracture is associated with increased 4-month mortality risk even after considering patient characteristics. The association between mortality and a short LoS, however, is explained by individuals coming from care homes (with higher mortality risk), being discharged early.

Reducing Catheter-Associated Urinary Tract Infection: The Impact of Routine Screening in the Geriatric Hip Fracture Population

BACKGROUND

Catheter-associated urinary tract infection (CAUTI) is a noted complication among geriatric hip fracture patients. This complication results in negative outcomes for both the patients and the institution providing care. Screening measures to identify predisposing factors, with early diagnosis and treatment of urinary tract infection (UTI) present on admission, may lead to reduced rates of CAUTI.

OBJECTIVE

The goals of this study were to determine the prevalence of UTI on admission among geriatric hip fracture patients and whether routine screening for UTI or predisposing factors at presentation resulted in reduced rates of CAUTI.

METHODS

A retrospective observational study of geriatric hip fracture patients from January 2017 to December 2018 at a Level I trauma center was performed. Rates of UTI on admission and CAUTI were calculated using routine admission urinalysis.

RESULTS

Of the 183 patients in the sample, 36.1% had UTI on admission and 4.4% of patients developed CAUTI. There were no significant differences in patient demographics, comorbidities, and complications between those with UTI on admission and those without.

CONCLUSIONS

Urinary tract infection on admission may be present among a large portion of geriatric hip fracture patients, leading to increased rates of CAUTI. Routine screening for UTI and its predisposing factors at admission can identify these patients earlier and lead to earlier treatments and prevention of CAUTI.

Clinical efficacy and therapeutic value of delayed surgery in patients with symptomatic old thoracolumbar fractures

Background

To investigate the clinical efficacy and therapeutic value of posterior decompression reduction, bone grafting fusion, and internal fixation for treatment of symptomatic old thoracolumbar fractures.

Method

Retrospective analysis was conducted for 14 patients (9 men, 5 women; average age 40.1 years) with old thoracolumbar fractures who underwent posterior operation. American Spinal Injury Association (ASIA) scores were used to evaluate neurologic function. Vertebral body height, Cobb angle in the sagittal plane, spinal canal volume ratio (%) and bone graft fusion were analyzed by radiography and computed tomography on different follow-up times.

Results

Mean follow-up was 27.1 months (23–36 months). Of three patients with ASIA grade A, 2 had improved postoperative urination and defecation, although no classification change. Preoperative ASIA score for eight patients with incomplete injury was grade B; four patients recovered to grade C at final follow-up. Preoperative ASIA score was C in three patients, increased to D in two patients and returned to normal E in one patient. Preoperative results showed average injured vertebra height loss rate decreased from 50.4 to 8.9%; average Cobb angle on the sagittal plane recovered from 39.6 to 6.9°; and the average spinal canal volume ratio recovered from 33.8 to 5.9%. Bony fusion was achieved; local lumbago and leg pain were relieved to some extent. No patients exhibited loosening of the fracture treated by internal fixation, pseudoarthrosis, or other related serious complications.

Conclusion

Treatment of old thoracolumbar fractures by posterior decompression reduction, bone grafting fusion, and internal fixation can relieve spinal cord compression, improve neurologic function of some patients (ASIA grades B–C), effectively relieve pain, correct deformity, restore biomechanical stability, and significantly improve quality of life.

Incidence, Risk-Factors and Associated Mortality of Complications in Orthogeriatric Co-Managed Inpatients

Introduction:

Pneumonia, thromboembolic and ischemic events, urinary tract infections (UTI), delirium and acute kidney injury (AKI) are common complications during the treatment of fragility fractures. In a 2 years-follow-up we determined the according incidence and risk factors of these and other complications in orthogeriatric inward patients, as well as the respective associated mortality.

Methods:

All patients treated on an orthogeriatric co-managed ward over the course of a year were included. Besides injury, therapy and geriatric assessment parameters, we evaluated the inward incidence of common complications. In a 2 years-follow-up the associated death rates were aquired. SPSS (IBM) was used to determine the importance of risk factors predisposing to the respective occurrence of a complication and accordingly determine it’s impact on the patients’ 1- and 2-years-mortality.

Results:

830 orthogeriatric patients were initially assessed with a remaining follow-up cohort of 661 (79.6%). We observed very few cases of thrombosis (0.6%), pulmonary embolism (0.5%), apoplex (0.5%) and myocardial infarction (0.8%). Pneumonia was seen in 42 (5.1%), UTI in 85 (10.2%), delirium in 186 (22.4%) and AKI in 91 (11.0%) patients. Consistently ADL on admission was found to be a relevant risk factor in the development of each complication. After adjustment only AKI showed a significant increased mortality risk of 1.60 (95%CI:1.086-2.350).

Discussion:

In our fracture-independent assessment of complications in the orthogeriatric treatment of inward patients we’ve seen very rare cases of cardiac and thrombotic complications. Typical fragility-fracture associated common events like pneumonia, UTI, delirium and AKI were still more incidental. No complication except AKI was associated to significant increased mortality risk.

Conclusions:

The relevance of orthogeriatric care in prevention and outcome of inward complications seems promising, needing still more controlled studies, evaluating not just hip fracture patients but more diverse groups. Consensus is needed in the scholar evaluation of orthogeriatric complications.

The incidence of severe urinary tract infection increases after hip fracture in the elderly: a nationwide cohort study

Although urinary tract infection (UTI) is a common perioperative complication among elderly patients with hip fracture, its incidence and effects are often underestimated. This study investigated the effects of severe UTI (S-UTI) on elderly patients with hip fracture and the risk factors for this condition. In this retrospective nationwide cohort study, we searched Taiwan's National Health Insurance Research Database from 2000 to 2012 for data on patients aged ≥ 50 years with hip fracture who underwent open reduction and internal fixation or hemiarthroplasty for comparison with healthy controls (i.e. individuals without hip fracture). The study and comparison cohorts were matched for age, sex, and index year at a 1:4 ratio. The incidence and hazard ratios of age, sex, and multiple comorbidities associated with S-UTI were calculated using Cox proportional hazard regression models. Among the 5774 and 23,096 patients in the study and comparison cohorts, the overall incidence of S-UTI per 100 person-years was 8.5 and 5.3, respectively. The risk of S-UTI was cumulative over time and higher in the study cohort than in the comparison cohort, particularly in those who were older, were female, or had comorbidities of cerebrovascular accident or chronic renal failure.

Antibiotic prophylaxis for urinary catheter manipulation following arthroplasty: a systematic review

BACKGROUND

Urinary catheter use in the peri- and post-operative phase following arthroplasty may be associated with urinary tract infection (UTI) and deep prosthetic joint infection (PJI). These can be catastrophic complications in joint arthroplasty. We performed a systematic review of the evidence on use of antibiotics for urinary catheter insertion and removal following arthroplasty.

METHODS

Electronic databases were searched using the Healthcare Databases Advanced Search interface. Grey literature was searched. From 219 citations, six studies were deemed eligible for review. Due to study heterogeneity, a narrative approach was adopted. Methodological quality of each study was assessed using the Critical Appraisal Skills Programme appraisal tool.

RESULTS

A total of 4696 hip and knee arthroplasties were performed on 4578 participants across all studies. Of these, 1475 (31%) were on men and 3189 (68%) on women. The mean age of study participants was 69 years. Three thousand four hundred and eighty-nine cases (74.3%) were related to hip arthroplasty and 629 (13.4%) to knee arthroplasty. Five hundred and seventy-eight (12.3%) were either hip or knee arthroplasty. Forty-five PJIs were reported across all studies (0.96%). Two studies found either no PJI or no statistical difference in the rate of PJI when no antibiotic prophylaxis was used for catheter manipulation. Another study found no statistical difference in PJI rates between patients with or without preoperative bacteriuria. Where studies report potential haematogenous spread from UTIs, this association can only be assumed. Increased duration of urinary catheterization is positively associated with UTI.

CONCLUSION

It remains difficult to justify the use of prophylactic antibiotics for catheter manipulation in well patients. Their use is not recommended for this indication.

More than a reposition tool: additional wire cerclage leads to increased load to failure in plate osteosynthesis for supracondylar femoral shaft fractures

INTRODUCTION

Surgical treatment of supracondylar femoral fractures can be challenging. An additional wire cerclage is a suggested way to facilitate fracture reduction prior to plate osteosynthesis. Denudation to the periosteum remains a problematic disadvantage of this procedure. This study analyzed the effect of an additional wire cerclage on the load to failure in plate osteosynthesis of oblique supracondylar femoral shaft fractures.

MATERIALS AND METHODS

On eight pairs of non-osteoporotic human femora (mean age 74 years; range 57-95 years), an unstable AO/OTA 32-A2.3 fracture was established. All specimens were treated with a polyaxially locking plate. One femur of each pair was randomly selected to receive an additional fracture fixation with a wire cerclage. A servohydraulic testing machine was used to perform an incremental cyclic axial load with a load to the failure mode.

RESULTS

Specimens stabilized with solely plate osteosynthesis failed at a mean load of 2450 N (95% CI: 1996-2904 N). In the group with an additional wire cerclage, load to failure was at a mean of 3100 N (95% CI: 2662-3538 N) (p = 0.018). Compression deformation with shearing of the condyle region through cutting of screws out of the condylar bone was the most common reason for failure in both groups of specimens. Whereas axial stiffness was comparable between both groups (p = 0.208), plastic deformation of the osteosynthesis constructs differed significantly (p = 0.035).

CONCLUSIONS

An additional wire cerclage significantly increased the load to failure. Therefore, an additional cerclage represents more than just a repositioning aid. With appropriate fracture morphology, a cerclage can significantly improve the strength of the osteosynthesis.

Should concurrent infections be treated before performing hip arthroplasty for hip fracture?

Aims

A systematic literature review focusing on how long before surgery concurrent viral or bacterial infections (respiratory and urinary infections) should be treated in hip fracture patients, and if there is evidence for delaying this surgery.

Methods

A total of 11 databases were examined using the COre, Standard, Ideal (COSI) protocol. Bibliographic searches (no chronological or linguistic restriction) were conducted using, among other methods, the Patient, Intervention, Comparison, Outcome (PICO) template. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for flow diagram and checklist. Final reading of the complete texts was conducted in English, French, and Spanish. Classification of papers was completed within five levels of evidence (LE).

Results

There were a total of 621 hits (526 COre; 95 Standard, Ideal) for screening identification, and 107 records were screened. Overall 67 full-text articles were assessed for eligibility, and 21 articles were included for the study question. A total of 46 full-text articles were excluded with reasons. No studies could be included in quantitative synthesis (meta-analyses), and there were many confounding variables including surgeons’ experience, prosthesis models used, and surgical technique.

Conclusion

Patients with hip fracture and with a viral infection in the upper respiratory tract or without major clinical symptoms should be operated on as soon as possible (LE: I-III). There is no evidence that patients with coronavirus disease 2019 (COVID-19) should be treated differently. In relation to pneumonia, its prevention is a major issue. Antibiotics should be administered if surgery is delayed by > 72 hours or if bacterial infection is present in the lower respiratory tract (LE: III-V). In patients with hip fracture and urinary tract infection (UTI), delaying surgery may provoke further complications (LE: I). However, diabetic or immunocompromised patients may benefit from immediate antibiotic treatment.

Cite this article: Bone Joint Res 2020;9(12):884–893.

Fascia Iliaca Compartment Block for Perioperative Pain Management of Geriatric Patients with Hip Fractures: A Systematic Review of Randomized Controlled Trials

Background

With continuous increase of the aging population, the number of geriatric patients with fragility hip fractures is rising sharply, and timely surgery remains the mainstay of treatment. However, adequate and effective pain control is the precondition of satisfactory efficacy. This systematic review aimed to summarize the use of fascia iliaca compartment block (FICB) as an analgesic strategy for perioperative pain management in geriatric patients with hip fractures.

Methods

PubMed and Embase databases were searched for English published randomized controlled trials (RCTs) reporting application of FICB for pain control of the older adults with hip fractures between January 1^st, 2000, and May 31^st, 2020. The modified Jadad scale was used to evaluate quality of the RCTs included. Primary outcomes of the eligible RCTs were presented and discussed.

Results

A total of 27 RCTs with 2478 cases were included finally. The present outcomes suggested, after admission or in the emergency department (ED), FICB can provide patients with equal or even better pain relief compared with the conventional analgesia methods, which can also reduce additional analgesic consumptions. While, before positioning for spinal anesthesia (SA), FICB is able to offer superior pain control, facilitating SA performance, after surgery FICB can effectively alleviate pain with decreased use of additional analgesics, promoting earlier mobilization and preventing complications.

Conclusions

FICB is a safe, reliable, and easy-to-conduct technique, which is able to provide adequate pain relief during perioperative management of geriatric patients with hip fractures.

Pull the Foley: Improved Quality for Middle-Aged and Geriatric Trauma Patients Without Indwelling Catheters

INTRODUCTION

Urinary tract infection (UTI) complications are often attributed to the inappropriate use of urinary catheters.

PURPOSE

We sought to examine the effectiveness of a hospital-wide policy aimed at reducing the use of indwelling Foley catheters.

METHODS

We completed a retrospective review of prospectively collected data on 577 hip and femur fracture patients aged 55 years and older who were operatively treated at a Level 1 trauma center between October 2014 and March 2019. New standard-of-care guidelines restricting the use of indwelling Foley catheters were implemented starting January 2018, and we compared perioperative outcomes between cohorts.

RESULTS

Over a 50% absolute reduction in indwelling Foley catheter use and a near 30% relative reduction in hospital-acquired UTI were achieved. Postpolicy cohort patients without indwelling Foley catheters experienced lower odds of hospital-acquired UTI, higher odds of home discharge, as well as decreased time to surgery, shorter length of stay, and lower total inpatient cost compared with those with indwelling Foley catheters.

CONCLUSIONS

The policy of restricting indwelling Foley catheter placement was safe and effective. A decrease in indwelling Foley catheter use led to a decrease in the rate of hospital-acquired UTI and positively affected other perioperative outcomes.

Hip fracture clearance: How much optimisation is necessary?

Patients with hip fractures are typically elderly individuals with several co-morbidities. Upon admission to the hospital, they often present with acute pain, electrolyte disturbances, anaemia, coagulopathy, and delirium. Long waiting times for surgery are associated with increased morbidity and mortality. The balance between the number of clinical tests and optimisation, which may (i.e., fewer complications and better survival) or may not (i.e., more complications and increased mortality due to unnecessary surgical delay) benefit the patient, has been a preoperative challenge. This summary will review existing clinical guidelines and relevant selected studies to evaluate the extent of preoperative optimisation needed prior to hip fracture surgery.

The identification of adverse events in hip fracture patients using the Global Trigger Tool: A prospective observational cohort study

INTRODUCTION

Hip fracture is common in the elderly and is associated with high comorbidity, mortality and complication rates. There has been an increase in the investigation of healthcare-related adverse events (AEs) in some patient groups but there is limited knowledge about hip fracture patients. The aim was to explore the incidence, preventability and nature of AEs in hip fracture patients.

METHODS

One hundred and sixty three hip fracture patients participated. A record review was conducted of prospectively collected data using Global Trigger Tool methodology to identify AEs up to 90 days after surgery.

RESULTS

Sixty two (38.0%) of 163 patients had at least one AE (range 1-7). One hundred and two AEs were identified and 62 (60.8%) were deemed preventable. Healthcare-associated infections e.g. pneumonia, urinary tract infections and pressure ulcers were common. AEs were more common in older patients and those with pre-existing health conditions. Fifty eight (56.9%) AEs caused temporary harm and 4 (3.9%) contributed to patient death.

CONCLUSION

AEs are common in hip fracture patients and most are preventable. If the focus is on improving healthcare for these patients, we should be concentrating our efforts on reducing the number of these preventable AEs, with a particular emphasis on improving the care of older patients with pre-existing health conditions.

The consistency of care for older patients with a hip fracture: are the results of the integrated orthogeriatric treatment model of the Centre of Geriatric Traumatology consistent 10 years after implementation?

In the past 10 years after implementation, the orthogeriatric treatment model led in general to consistent outcomes for 1555 older adults in terms of most of the complications and mortality. Surgery was more often delayed to 24-48 h after arrival at the hospital, while the length of hospital stay shortened.

INTRODUCTION

Since 1 April 2008, patients aged ≥ 70 years presenting themselves with a hip fracture at Ziekenhuisgroep Twente (ZGT) have been treated according to the orthogeriatric treatment model. The aim of this study was to investigate if outcomes of the orthogeriatric treatment model are consistent over the first 10 years after implementation.

METHODS

Between 1 April 2008 and 31 December 2016, patients aged ≥ 70 years who were surgically treated at ZGT for a hip fracture were included and divided into three periods equally distributed in time. Patient characteristics, in-hospital logistics, complications, and mortality data were compared between the three periods.

RESULTS

A total of 1555 patients were included. There was a shift in the surgical treatment for the fractured neck of femur from dynamic hip screw/cannulated screws to hemiarthroplasty (p < 0.001). Surgery within 24 h after arrival to the hospital decreased (p < 0.001), while surgery within 48 h stayed the same (p = 0.085). Length of hospital stay significantly decreased over time (p < 0.001). Complication rates were consistent except for the number of postoperative anemia, delirium, and urinary tract infections. Mortality rates did not change over the years.

CONCLUSIONS

The orthogeriatric treatment model leads in general to consistent outcomes concerning mortality and most of the complications, except for postoperative anemia, delirium, and urinary tract infections. Inconsistent complication rates were influenced by altered diagnosis and treatment protocols. Length of hospital stay reduced, while time to surgery was more often delayed to 24-48 h. Monitoring clinical outcomes of the orthogeriatric treatment model over time is recommended in order to optimize and maintain the quality of care for this frail patient population.

Urinary tract infections in a geriatric sub-acute ward-health correlates and atypical presentations

Purpose

Bacterial urinary tract infections (UTIs) are the most frequently occurring infectious diseases in the geriatric population. The aim of the study was to determine the prevalence and clinical features of UTIs in geriatric in-patients and their association with health and functional ability characteristics.

Methods

A prospective cross-sectional cohort study was conducted among patients hospitalized on the geriatric ward. Patients were interviewed, examined, and had their hospital records analyzed. An uncontaminated midstream urine sample was collected and cultured in all of the cases suspected for UTI. Relative risks for UTI were counted and multivariable logistic regression model was built.

Results

246 patients were included, 179 (72.8%) women, 210 (85.4%) 75 + -year-olds. Bacterial UTIs occurred in 18.3% of the patients. The main etiological agent was Escherichia coli (73.3%). The most significant predictors of UTI were recurrent UTI and urinary catheter. The typical clinical UTI symptoms occurred in less than half of the cases (only in 11.1% of cases fever was observed). More often, than in patients without UTIs, they reported symptoms such as delirium (28.9% vs. 18%), tachycardia (11.1% vs. 1.5%) or hypotension (20% vs. 12.1%).

Conclusions

Bacterial UTIs affect about 1/5 of hospitalized geriatric patients. The clinical picture of these infections very often is atypical and it indicates a need for diagnostic vigilance.