AS INFECÇÕES DO SISTEMA URINÁRIO CAUSADAS POR MICROORGANISMOS MULTIRRESISTENTES EM PACIENTES IDOSOS: UMA REVISÃO SISTEMÁTICA.

Abstract

Urinary Tract Infections (UTIs) represent an important public health problem, especially among older adults, due to their high incidence, recurrence, and association with multidrug-resistant microorganisms. These infections mainly affect the bladder and kidneys and are predominantly caused by Gram-negative bacteria, especially Escherichia coli. Aging, associated with comorbidities, frequent hospitalizations, use of urinary devices, and immunosenescence, increases susceptibility to UTIs and antimicrobial resistance. Objective: To analyze the epidemiological, microbiological, therapeutic, and prognostic aspects of UTIs in elderly patients, emphasizing factors related to bacterial multidrug resistance and its clinical impacts. Methodology: This study consists of a systematic literature review developed according to PRISMA recommendations, using scientific studies related to UTIs, antimicrobial resistance, and multidrug-resistant bacteria in older adults. Articles addressing microbiological mechanisms, risk factors, clinical impact, and therapeutic approaches associated with urinary infections were analyzed. Results and Discussion: The analyzed studies demonstrated that UTIs in older adults have high clinical relevance due to increased morbidity and mortality, hospitalizations, and therapeutic limitations associated with antimicrobial resistance. Multidrug-resistant Gram-negative bacteria were found to exhibit adaptive mechanisms such as production of inactivating enzymes, alterations in antimicrobial targets, reduced membrane permeability, efflux pumps, and biofilm formation. In addition, horizontal gene transfer favors the spread of bacterial resistance. The main risk factors associated with complicated UTIs included advanced age, comorbidities, urinary catheter use, recurrent hospitalizations, and institutionalization. The findings reinforce the need for individualized therapies, rational use of antimicrobials, and integration between rapid diagnosis, epidemiological surveillance, and multidisciplinary management. Final Considerations: It is concluded that addressing UTIs in older adults requires an integrated approach based on early diagnosis, rational antibiotic use, microbiological surveillance, and individualized therapies. The association between science, technology, and humanized care is essential to reduce bacterial resistance and promote safer and more effective treatments.