Geriatric Trauma patients admitted for a fall are more likely to have a Community Acquired UTI

Author(s):
Leonardo Diaz; Jose Aldana; Melissa Canas; Ricardo Fonseca; Hussain Afzal; Kelly Marie Bochicchio; Jennifer Leonard; Grant Bochicchio

Background:

Falls are the leading cause of injury in the United States and the primary etiology of accidental deaths in patients over 65 years old. Urinary Tract Infection (UTI) is the most common community-acquired infection in the elderly. Few studies have evaluated whether there is an association between community-acquired UTI (CA-UTI) and falls in geriatric patients.

Hypothesis:

We hypothesized that geriatric patients admitted for falls have a higher incidence of CA-UTI.

Methods:

We queried our prospectively maintained trauma database spanning January 2019 to August 2021 or patients older than 65 years that were admitted to our level one trauma center. We stratified the patients by mechanisms of injury (fall vs non-fall) and then sub-stratified in CA-UTI vs NON CA-UTI. We determined this diagnosis by CDC guidelines (infection diagnosed within the first 72 hours of admission). Demographics and outcomes were analyzed using Student’s t-test and Chi^–square analysis in SPSS.

Results:

From January 2019 to August 2021, 5257 trauma patients older than 65 years old were admitted. 3764 patients (72%) were admitted for falls and 1493 (28%) were admitted for other mechanisms. The majority of the fall patients were female (56.8%). Although ISS (8.9±1 vs 9.3 ±0.2 p<0.001), hospital length of stay (5.7±0.1 vs 5.8 ±0.3 p<0.001), and mortality (3.9% vs 6% p<0.001) were all significantly higher in the non-fall group, the majority of the CA-UTIs were diagnosed in fall patients (93.9% vs 6.1% p<0.001). Within the fall group, we found that patients with CA-UTI were significantly older (89.1±9.6 vs 74.7±11 p<0.001) and more likely to be female (79% vs 21% p<0.001).  There was however no significant difference in outcome as measured by length of stay, and mortality when compared with the NON-CA UTI patients. When analyzed by logistic regression controlling for CA-UTI, age and ISS, we found that CA-UTI was 3 times more likely to be associated with a fall (OR 3.06, CI 1.103 – 8.655, 95% p<0.035).

Conclusions:

Geriatric patients admitted after a fall had a significantly higher likelihood of having a UTI on admission when compared to non-fall patients. Based on these findings, we believe that strong consideration should be made for screening these patients in order to provide earlier treatment and avoid progression of the infection.