Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England

Abstract

Background Research has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged �65 years in primary care. Methods and findings We analyzed primary care records from patients aged �65 years in England with community-onset UTI using the Clinical Practice Research Datalink (2007-2015) linked to Hospital Episode Statistics and census data. The primary outcome was BSI within 60 days, comparing patients treated immediately with antibiotics and those not treated immediately. Crude and adjusted associations between exposure and outcome were estimated using generalized estimating equations. A total of 147,334 patients were included representing 280,462 episodes of lower UTI. BSI occurred in 0.4% (1,025/244,963) of UTI episodes with immediate antibiotics versus 0.6% (228/35,499) of episodes without immediate antibiotics. After adjusting for patient demographics, year of consultation, comorbidities, smoking status, recent hospitalizations, recent accident and emergency (A&E) attendances, recent antibiotic prescribing, and home visits, the odds of BSI were equivalent in patients who were not treated with antibiotics immediately and those who were treated on the date of their UTI consultation (adjusted odds ratio [aOR] 1.13, 95% CI 0.97-1.32, p-value = 0.105). Delaying or withholding antibiotics was associated with increased odds of death in the subsequent 60 days (aOR 1.17, 95% CI 1.09-1.26, p-value < 0.001), but there was limited evidence that increased deaths were attributable to urinary-source BSI.

Clinical Profile, Prognostic Factors, and Outcome Prediction in Hospitalized Patients With Bloodstream Infection: Results From a 10-Year Prospective Multicenter Study

“…Accurate identification of predictors associated with mortality in patients with BSI is critical to informing clinical interventions and improving clinical outcomes. Although some prognostic factors have been identified as potential predictors for BSI mortality, most previous reports particularly focused on a single group of people, such as children or the aged, or with specific clinical conditions including cancer and trauma as well as causative organisms equipped with multidrug resistance (8)(9)(10)(11). In addition, multiple machine learning approaches have been developed and increasingly used in predicting unfavorable outcomes and in identifying predictors of mortality for different types of disease, with better performance than the classical multivariate regression analysis method (12).…”

Thematic research clusters in very old populations (≥ 80 years): a bibliometric approach

“…Finally, the cluster around bacterial infections and anti-bacterial agents shows the importance of clinical entities like urinary tract infections and infections associated with the implantation of prostheses, especially those caused by staphylococci and Klebsiella spp., in very old people [ 55 ]. Urinary tract infections—often aggravated by bacterial resistance [ 56 ]—are the most common infections in this population due to the degenerative nature of the urinary tract [ 57 ], and they are also responsible for worsening patients’ functional status. Research addressing this problem has seen notable growth in the past several years around questions like multidrug resistance and the most appropriate treatments for different types of infections [ 33 ].…”

Thematic Research Clusters in Very Old Populations (≥ 80 Years): a Bibliometric Approach

“…Finally, the cluster around bacterial infections and anti-bacterial agents shows the importance of clinical entities like urinary tract infections and infections associated with the implantation of prostheses, especially those caused by staphylococci and Klebsiella spp., in very old people [55]. Urinary tract infections-often aggravated by bacterial resistance [56]-are the most common infections in this population due to the degenerative nature of the urinary tract [57], and they are also responsible for worsening patients' functional status. Research addressing this problem has seen notable growth in the past several years around questions like multidrug resistance and the most appropriate treatments for different types of infections [33].…”