Geriatrik Nefroloji

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DOI :10.26650/B/CH12CH47.2023.014.14   IUP :10.26650/B/CH12CH47.2023.014.14    Tam Metin (PDF)

Yaşlı Hastalarda Üri̇ner Si̇stem Enfeksiyonları Ve Tedavi̇si̇

İlyas Öztürk, Fatma Betül Güzel, Özkan Güngör

Üriner sistem enfeksiyonları (ÜSE) yaşlı hastalarda sık görülür ve asemptomatik bakteriüriden ürosepsise kadar değişik spektrumlarda ortaya çıkabilir.1 Özellikle yaşlı kadınlarda erkeklerden daha sık gözlenir. Gençlerde, kadın erkek oranı 50:1 ile kadın cinsiyet yönünde baskınken, 70 yaşın üzerindeki hastalarda bu oran 2:1 civarındadır.2 Kadınlarda sık olmasının sebebi üretranın daha kısa olması nedeniyle patojen mikroorganizmaların daha kolay geçebilmesidir.3 Fakat cinsiyetten bağımsız olarak yaşla birlikte her iki cinsiyette de artış göstermektedir.4 Yaşlılarda yıllık ÜSE insidansı %20 civarındadır, bakımevlerinde kalan yaşlılarda bu oran %50’ye kadar çıkabilir.5 Üriner sistem enfeksiyonlarının gelişiminde kolaylaştırıcı faktörler; yaşlı kadınlarda östrojen eksikliği, yaşlı erkeklerde ise prostat hastalıkları ve bakterisidal etkisi olan prostat sekresyonlarının azalması olarak sayılabilir. Her iki cinsiyette ortak olan kolaylaştırıcı faktörler ise idrar sondası kullanımı, üriner sistemin anatomik bozuklukları (rektosel, üretrosel, mesane divertikülü), üretral darlıklar, üretral girişimler, üriner inkontinans, mesane prolapsusu, mesane atonisi, perineal kaslarda zayıflama, şuur değişiklikleri, artan perineal kötü hijyen, seyrek idrar yapma, rezidü idrar, vezikoüreteral reflü olarak sayılabilir.6 Yaşlı kadınlarda postmenopozal östrojen eksikliğine ve laktobasillerin azalmasına bağlı intravajinal pH yüksektir, buna bağlı olarak kolonize mikroorganizmalarda değişiklik ve üroepitelyumda artan bakteri yapışması gözlenmesi ÜSE gelişiminde kolaylaştırıcı bir faktör olmaktadır.2,7-8 İşeme sonrası rezidü idrar ise pelvik kas yapısındaki değişiklere, erkeklerde prostat hipertrofisine bağlı olabilir. Demans, nöromüsküler bozukluklar ve antikolinerjik kullanımı bu durumu şiddetlendirebilir.2



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