Aeromonas hydrophila Urinary Tract Infection in an Elderly Patient: Clinical and Therapeutic Challenges in a Low-Resource Setting: A Case Report

Background Urinary tract infections (UTIs) in the elderly represent a significant diagnostic challenge due to atypical clinical presentations with absence of classic symptoms. With changing bacterial ecology in elderly UTIs, shifting from gram-negative bacteria to gram-positive cocci, culture becomes crucial for diagnosis and management. This is particularly challenging in low- and middle-income countries where culture facilities are not always available or accessible, and financial constraints serve as a hindrance to optimal care. Among uncommon causative agents are Aeromonas species, which present diagnostic and treatment challenges due to antimicrobial resistance and potential multisystemic complications if untreated. Case Presentation: We report a rare case of Aeromonas hydrophila UTI in an 82-year-old frail Cameroonian patient with known benign prostatic hyperplasia (BPH). The patient presented with confusion, refusal to feed and acute urinary retention (AUR) without classic lower urinary tract symptoms. Urine culture yielded Aeromonas hydrophila, with identification confirmed by API 20E (BioMérieux SA, France) and antimicrobial susceptibility testing showing sensitivity to ciprofloxacin. A diagnosis of UTI secondary to Aeromonas hydrophila was made, though no source of contamination was identified in his history. The patient was successfully treated with 10 days of oral ciprofloxacin and discharged. Conclusion Aeromonas hydrophila may be considered a potential aetiology of UTIs in Cameroon, alongside more commonly encountered bacteria like E. coli, particularly in elderly patients. This case underscores the critical importance of obtaining urine cultures with antimicrobial susceptibility testing to guide appropriate targeted therapy, especially in elderly patients whose clinical presentation may be polymorphic and whose comorbidities and polypharmacy necessitate prompt and appropriate management.