Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections

Esparcia, Ana; Artero, Arturo; Eirós, José María; Balaguer, Marcelino Gómez; Madrazo, Manuel; Alberola, Juan; Nogueira, José Miguel

doi:10.1016/j.ejim.2014.04.009

Cited by 52 publications

(56 citation statements)

References 29 publications

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“…The diagnosis of a UTI required a history of fever, and a positive urine or blood culture8 but without a source of fever outside the urinary tract.…”

Section: Methodsmentioning

confidence: 99%

Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

et al. 2016

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PurposeTo determine the consequences of treating febrile geriatric patients with a suspected urinary tract infection (UTI) with antibiotics that have high resistance rates due primarily to extended-spectrum β-lactamase (ESBL) producing bacteria.MethodsIn this cohort study, we selected 257 consecutive hospitalised patients aged ≥70 years with a chief symptom of fever, possibly due to a UTI and initially treated with antibiotics with rates in our hospital of urinary culture resistance >20%. Patients with severe sepsis were excluded. The main outcomes measures were in vitro bacterial resistance to initial antibiotic therapy (BRIAT), response to therapy, hospitalisation days and mortality.ResultsUrine cultures were positive in 64.2% (165 of 257) of the patients and BRIAT occurred in 28.0% (72 of 257). Response rates were 100% (93 of 93) in those with bacteria sensitive to initial antibiotic therapy, 95.7% (88 of 92) in the culture negative patients, and 66.7% (48 of 72) in those with BRIAT (p<0.001). There were no deaths due to deterioration during the initial treatment period because of BRIAT. In the patients with BRIAT, the median length of hospitalisation was 3 days longer than that in the other patients (7 and 4 days, respectively, p<0.001).ConclusionsWe conclude that initial broad spectrum antibiotic treatment could potentially lower the median length of hospitalisation by 3 days in many hospitalised geriatric patients without an extra-urinary tract source for their fever. This benefit needs to be balanced against the risk to the individual patient and to the general public of increasing bacterial resistance rates to broader spectrum antibiotics often held in reserve.

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“…The diagnosis of a UTI required a history of fever, and a positive urine or blood culture8 but without a source of fever outside the urinary tract.…”

Section: Methodsmentioning

confidence: 99%

Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

et al. 2016

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Section: Inappropriate Antibiotic Therapy In Cuti and Catheter-associmentioning

confidence: 96%

“…Esparcia et al, in their study of elderly patients with severe UTIs, demonstrated that inadequate empiric antibiotic therapy was associated with previous hospitalization, presence of a urinary catheter and previous receipt of an antibiotic [26]. They also showed that inadequate empiric antibiotic therapy was an independent risk factor of mortality [26]. In a retrospective matched-cohort analysis, MacVane et al showed that the cost of care and length of stay for patients with a UTI infection due to ESBL-producing E. coli or K. pneumoniae were 1.5 times greater than for those caused by non-ESBL-producing E. coli or K. pneumoniae [27].…”

Section: Inappropriate Antibiotic Therapy In Cuti and Catheter-associmentioning

confidence: 97%

Focus on ceftazidime-avibactam for optimizing outcomes in complicated intra-abdominal and urinary tract infections

Nicolau

2015

Expert Opinion on Investigational Drugs

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The increasing problem and complexity of β-lactamase resistance has been met by resurgence in the development of β-lactamase inhibitor combinations. These show promise in the treatment of resistant infections. One β-lactamase inhibitor in advanced development with a broad spectrum of activity is avibactam, covering class A, class C and some class D enzymes. Importantly, the activity of avibactam also includes carbapenemases such as the KPC and OXA-48. The combination of avibactam with the cephalosporin ceftazidime is attractive, given the spectrum of antimicrobial activity and the low toxicity of the cephalosporin class.

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“…This results in frequent inadequate empirical antibiotic therapy for HA-UTI, with rates as high as 30.5% to 67%. 3,4 methods The study was conducted at Tufts Medical Center, a 415-bed, level I trauma and tertiary care center in Boston, Massachusetts. The novel antibiogram included urine cultures from 2013 adult inpatients.…”

mentioning

confidence: 99%

“…Infect Control Hosp Epidemiol 2016; [1][2][3][4] The 2014 updated Clinical and Laboratory Standards Institute guidelines emphasize the value of an "enhanced antibiogram," which is stratified by infection characteristics and includes features such as susceptibilities for antibiotic combinations. 1 The objective of this study was to apply the weightedincidence syndromic combination antibiogram to healthcareassociated (HA) infections.…”

mentioning

confidence: 99%

Evaluation of a Healthcare-Associated Urinary Tract Infection Combination Antibiogram

Wick

Beaulac

Doron

2016

Infect. Control Hosp. Epidemiol.

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We created a 2013 combination antibiogram of healthcare-associated urinary tract infection. The 2013 antibiogram-determined regimen was evaluated in a 2014 cohort who had received empirical therapy. The regimen was statistically more likely to represent adequate treatment than actual prescriptions. A customized antibiogram may guide empirical therapy for specific patients. Infect Control Hosp Epidemiol 2016;37:1101-1104.

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Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections

Cited by 52 publications

References 29 publications

Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study

Focus on ceftazidime-avibactam for optimizing outcomes in complicated intra-abdominal and urinary tract infections

Evaluation of a Healthcare-Associated Urinary Tract Infection Combination Antibiogram

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