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)
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.
 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