Urinary tract infections (UTI) are one of the most common bacterial infections affecting geriatric patients and the main source of community acquired bacteremia. After pneumonia, UTI represent the second cause of hospital admission due to an infection in the older adults. Despite their high frequency, UTI are frequently overdiagnosed due to the high prevalence of asymptomatic bacteriuria (ASB) in older populations which may lead to an incorrect diagnostic and unnecessary antimicrobial treatment in the presence of non-specific urinary symptoms. This increased exposure to antimicrobials is one of the main factors explaining the high prevalence of UTI due to MDRO in the older adults including those caused by extended-spectrum betalactamase (ESBL) producing Enterobacteriaceae.
Women are more prone to experience UTI although rates tend to equalise in ageing males due to impaired normal voiding mainly associated with benign prostatic hyperplasia (BPH). The main consequence of these voiding difficulties is the generation of a retrograde turbulent urine flow, enabling the ascension of uropathogens to the bladder and eventually into the prostate, which explains the high frequency of prostatic involvement in males with UTI. Therefore, most febrile UTI (FUTI) in males should be considered as acute bacterial prostatitis (ABP) and treated using antimicrobials with an adequate prostatic diffusion such as fluoroquinolones (FQ). Increasing antimicrobial resistance rates hinder the eradication of the bacteria from the prostate thus becoming the source of recurrent UTI in males.