Prophylactic therapy should be avoided in patients with indwelling bladder catheters. An alternative is treatment with IV TMP-SMX or a quinolone. Urosepsis in elderly persons may give rise to high morbidity and mortality rates. Although the highest recommended initial dose should be used, subsequent doses usually need to be reduced substantially because of decreased renal function in the elderly. Maintenance of fluid and electrolyte balance as well as of adequate blood pressure is critical.
Treatment depends on the underlying etiology.
Management of uncomplicated reinfection UTI includes hydration and acidification of urine and low-dose suppressive antibiotic therapy. Avoiding or promptly discontinuing catheter use as soon as possible is recommended. At any given time, an estimated 100,000 elderly nursing home residents have long-term indwelling urinary catheters. Bladder calculi can also result in sustained bacteriuria that is difficult to treat even with antibiotics. Development of bacteriuria is facilitated by poorly controlled diabetes mellitus, because increased urine glucose levels provide the substrate for bacterial growth.