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Delaying or withholding antibiotics in older adults with urinary tract infections (UTIs) is associated with an increased risk of bloodstream infection and all-cause mortality, research published in The
BMJ has shown (27 February 2019)[1]
.
The study used UK general practice data from 2007 to 2015 on 157,264 adults aged 65 years and over who experienced a total of 312,896 UTI episodes. Overall, 22,534 patients (7.2%) were not treated with antibiotics and 19,292 (6.2%) received a delayed antibiotic prescription within seven days of diagnosis.
Compared with receiving immediate antibiotics, the risk of bloodstream infection within 60 days was elevated eight-fold with no antibiotics and seven-fold with delayed antibiotics. The risk of all-cause mortality was also significantly increased by 118% and 16%, respectively.
Men aged 85 years or over were at particular risk for both bloodstream infection and 60-day all-cause mortality.
The researchers explained that while antimicrobial stewardship efforts have reduced antibiotic prescribing in primary care, including for UTIs, there had been a concomitant increase in Gram-negative bloodstream infections in England.
They said their results suggested that delaying or withholding antibiotics may not be an appropriate strategy in this age group.
“Early initiation of recommended first-line antibiotics for UTI in the older population is advocated,” they concluded.
References
[1] Gharbi M, Drysdale J, Lishman H et al. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all-cause mortality: population based cohort study. BMJ 2019;364:l525. doi: 10.1136/bmj.l525
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