The prevalence and risk factors for urinary tract infection in elderly patients presenting with proximal femoral fractures: a prospective observational study


  • C Pretorius University of Pretoria
  • R J Immelman University of Pretoria
  • F Ismail University of Pretoria
  • M V Ngcelwane University of Pretoria
  • N S Motsitsi University of Pretoria


proximal femoral insufficiency fractures, urinary tract infection, urine microscopy culture and sensitivity, risk factors, prevalence


Background: Proximal femoral insufficiency fractures are increasingly common in the elderly population. Urinary tract infection (UTI) is the most common associated complication in this group of patients with these injuries and may add to an already severe morbidity and mortality. The incidence of patients presenting with an established UTI from home is unknown as most research focuses on UTIs that occur after hospital admission. The aim of the study was to determine the prevalence of UTIs on admission and to compare urine culture results and patient profiles of these patients.

Methods: Forty patients presenting with a proximal femoral insufficiency fracture were identified on admission to casualty. A urine specimen was taken according to a standard protocol and sent for microscopy, culture and sensitivity (MCS). The organism and sensitivity profiles were determined from all positive MCS samples. Risk factors and patient demographics were identified using a questionnaire.

Results: Twenty of the 40 patients (50%) had a positive culture from the urine MCS. The most common organism was Escherichia coli (55%) [CI = 33.2; 76.8%] and the most common antibiotic sensitivity was to amoxicillin/clavulanic acid. Most of the organisms identified were resistant to ampicillin/amoxicillin and trimethoprim/sulfamethoxazole. Significant risk factors associated with an increased prevalence were female sex and the age of the patient.

Conclusion: The prevalence of UTI in elderly patients with proximal femoral fractures is underestimated. Higher risk patients for presenting with a UTI from home are the elderly female patients above 80 years of age. Screening for, diagnosing and treating UTIs earlier has clear benefits for this specific group of patients to potentially decrease overall morbidity and mortality.

Level of evidence: Level 4

Author Biographies

C Pretorius, University of Pretoria

MBChB(Wits), MMed(Orth)(Pret) (5th year), FC(Orth)(SA); Orthopaedic Surgeon, Steve Biko Academic Hospital, Pretoria

R J Immelman, University of Pretoria

MBChB(Pret), MMed(Orth)(Pret), FC(Orth)(SA); Orthopaedic Surgeon, Kalafong Hospital, Pretoria

F Ismail, University of Pretoria

BSc, MBChB(Pret), DTM&H(Wits), MMed(Medical Microbiology)(Pret); Medical Microbiologist, National Institute of Communicable Diseases/National Health Laboratory Services, Department of Medical Microbiology, University of Pretoria

M V Ngcelwane, University of Pretoria

MBChB(Natal), FCS(Orth)(SA), MSc(Orth)(London); Professor & Head of Department of Orthopaedic Surgery, Steve Biko Academic Hospital, Pretoria

N S Motsitsi, University of Pretoria

MBChB, MMed(Orth)(Medunsa), FCS(ASEA); Professor & Head of Department of Orthopaedic Surgery, Kalafong Hospital MBChB(Natal), FCS(Orth)(SA), MSc(Orth)(London); Professor & Head of Department of Orthopaedic Surgery, Steve Biko Academic Hospital, Pretoria