Key words: Urinary tract infections, Sequelae of cerebrovascular disorders, Bedridden

Key words: Urinary tract infections, Sequelae of cerebrovascular disorders, Bedridden

Table 1 Numbers and percentage of microorganisms isolated from 1267 urinary cultures (ABPC),Cephaloridine (CER), Tetracycline (TC), Chloramphenicol (CP), Erythromycin (EM), Kanamycin (KM), Gentamicin (GM), Dibekacin (DKB), Colistin (CL), Nalidixic acid (NA). * percentage of specimens containing this organism out of 1267 cultures, ** Pr.mirabilis, Pr.vulgaris, pr.mor- *5 ganii, Pr.rettgeri,and Pr.inconstans Table 2 Mixed infections in 297 urinary tract infections

Table 3 Incidence of urinary tract infection of the aged Table 4 Incidence of microorganisms isolated from 222 Urinary cultures of the aged patients with disturbance in the gait Fig. 1 Relationship between motor disturbance of knee joint and incidence of UTI of bedridden patient * Samples examined, ** Percentage of cultures positive

* Samples examined, ** include severe contractured group, rigidity group,and flaccid paralysed group,*** Percentage of cultures positive Table 6 Annual frequency of microorganisms isolated from urinary cultures of the aged Fig. 2 Annual changes in aerobic Gram negative rods isolated from urine

Fig. 3 Changes in dosage of antimicrobial agents Fig. 4 Changes of antimicrobial (*No. of strains) susceptibility

Fig. 5 Percentage of susceptible strains to various antimicrobial agents E.coli (208 strains) Klebsiella (94 strains) Pr. mirabilis (76 strains) Pr. vulgaris (106 strains) Pr. morganii (63 strains) Pr. rettgeri (8 strains) Pr. inconstans (21 strains) Ps. aeruginosa (126 strains) Str. faecalis (160 strains)

Fig. 6, Microbiological course of patients with UTI Table 7 Effect of antimicrobial therapy on the microorganisms of urine microbisme selectionnb et substitue, ** the same bacterial species were at the beginning of the theranv that isolated decrease in the bacterial cell counts, no change in A: B: the bacterial counts cell

Fig. 8 Microbiological course of a patient with UTI Fig. 7 Microbiological course of a patient with UTI

Table 8 Relationship between leucocytes and bacterial cell counts in urine Fig. 9 Relationship between organisms and leucocytes in urine Table 9 Relationship between microorganisms and leucocytes in urine Table 10 Numbers and percentage of organisms isolated from 25 vaginal cultures Table 11 Frequency of occurence of organisms isolated from 25 vaginal cultures * percent of specimens containing this organism out of 25 cultures, ** glucose nonfermentative gram negative rods

Table 12 Bacteria isolated from urine of the aged

3) Cape, R.D.T.: Management of Bacteriuria in the Elderly Female, in Urinary Tract Infection, eds Brumfitt, W., and Asscher, A.W., Oxford Univ. Press. London, 1973, p. 223-236. 4) MaMillan, S.A.: Bacteriuria of Elderly women in Hospital: Occurrence and Drug Resistance. Lancet, 11: 452-455, 1972. 5) Curtis, J.R.: Urinary Tract Infection in the Elderly Woman. J. Geront., 22: 502-509, 1967. 6) Kaitz, A.L. & Williams, E.J.: Bacteriuria and Urinary Tract Infections in Hospitalized Patients. New Eng. J. Med., 262(3): 425-430, 1960. 8) Bush, I.M., Orkin, L.A. & Winter, J.: An Eleven-year Study of Urinary Bacterial Cultures in a Total In-Patient Hospital Popula- tion. J. Urol., 94: 168-171, 1965. 17) Kunin, C.M.: Asymptomatic bacteriuria. Ann. Rev. Med., 17: 383-406, 1966. 19) Wolfson, S.A., Kalmanson, G.M., Rubini, M.E. & Guze, L.B.: Epidemiology of Bac- in a Predominantly Geriatric Male teriuria Population. Amer. J. Med. Sci., 250: 168-173, 1965. 20) Kass, R.H., et al.: The Significance of Bacteriuria in Preventive Medicine, in Pro-

gress in Pyelonephritis, ed. Kass, E. H., Davis, F. A. & Co., Philadelphia, 1969, p. 3-10. 1974, p.19-35. 748, 1977. 23) Prier, J. E. & Friedman, H.: Opportunistic Pathogens, University Park Press, Baltimore, 22) Corbishley, C. M.: Microbial flora of the vagina and cervix. J. Clin. P2thol., 30: 745 A Clinical Microbiological Study on Urinary Tract Infection of the Aged with Sequelae of Cerebrovascular Disorders,Jun OKADA Department of Clinical Pathology, Juntendo University School of Medicine The old bedridden patients, especially in combination with the sequelae of cerebrovascular disorders, are frequently suffered from urinary tract infections (UTI). This paper reviews the clinical microbiological study on UTI of the aged. 638 mean aged 75 yr bedridden patients (159 male, 479 female), who admitted to Koseiso Hospital, Tama Institute for Adult Diseases, between 1974 and 1979, because of the sequelae of cerebrovascular disorders were studied for the purpose of observing annual incidence of microorganisms. Samples for quantitative culture examinations were obtained by urinary catheter, and in some female cases, vaginal microbilological examinations were also performed. Results were as follows: 1) A total of 1901 strains of microorganisms were isolated from 1267 cultures during six years observation. The most important infecting organisms were Staph.aureus, E.coli, Klebsiella, indole positive Proteus groups. Comparing the annual frequency of the organisms, there was the decrease in the proportion of Staph.aureus, Klebsiella, Pr.mirabilis in the year from 1976 to 1979, whereas E.coli, indole positive Proteus groups and Ps.aeruginosa were increasing year by year, especially very striking was the rise of the percentage of indole positive Proteus groups, which were found in 18% of samples during 1974, in 26% during 1975, in 39% during 1978, and in 34% during 1979. Another interesting features is that very often mixed infections with these organisms were observed. 2) In annual change of antimicrobial susceptibilities against commonly used antimicrobials to the isolates, the rise in frequency of antimicrobial resistant strains was observed year by year, especially in the predominant isolates of Proteus groups. 3) Among 56 cases of UTI, 8 cases (14.3%) presented a change of the original bacteria after a course of antibacterial treatment. 4) A total of 25 vaginal specimens were collected from female bedridden patients. In vaginal cultures, numorous species were recovered. Many of them were gram negative rods, but other bacteria of low pathogenicity, so called "opportunistic pathogens" such as glucose nonfermentative gram negative rods, anaerobes and fungi, were also isolated. These results indicated that many cases of UTI of the aged were complicated type of infection and sometimes took longterm course with change of spectrum of bacteria, and was often in combination with mixed infection due to resistant type of oragnisms. These facts represent a serious problem in antimicrobial chemotherapy. Effective chemotherapy, of course, seems to be essential condition for a treatment of these infections. In addition to this, good nursing care, maintenance of hygine including urinary bladder and vagina are also important measures for prevention and treatment for these types of UTI.