FRIDAY, March 1, 2019 — Delaying or withholding antibiotics for older patients with a urinary tract infection (UTI) is associated with an increase in bloodstream infection and all-cause mortality, according to a study published online Feb. 27 in The BMJ.
Myriam Gharbi, Pharm.D., M.P.H., Ph.D., from Imperial College London, and colleagues conducted a retrospective population-based cohort study to examine the correlation between antibiotic treatment for UTI and severe adverse outcomes in elderly patients in primary care. Data were included for 157,264 adults aged 65 years or older presenting to a general practitioner with at least one diagnosis of suspected or confirmed lower UTI.
The researchers found that 7.2 percent of the 312,896 UTI episodes did not have a record of antibiotics being prescribed, while a delay in prescribing was seen in 6.2 percent. Patients were significantly more likely to experience a bloodstream infection in the deferred-antibiotics group and the no-antibiotics group versus the immediate-antibiotics group after adjustment for covariates (adjusted odds ratios, 7.12 and 8.08, respectively). Compared with those prescribed immediate antibiotics, cases with no antibiotics and deferred antibiotics had about double the rate of hospital admissions (27 and 26.8 percent, respectively, versus 14.8 percent). At any time during 60-day follow-up, the risk for all-cause mortality was significantly higher with deferred and no antibiotics versus immediate antibiotics (adjusted hazard ratios, 1.16 and 2.18, respectively).
“There is a need to improve the understanding of the effects of deferred antibiotic prescribing in routine practice,” the authors write.
Posted: March 2019
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