Delaying antibiotics for UTI in over-65s may not be safe

  • Gharbi M & al.
  • BMJ
  • 27 Feb 2019

  • curated by Dawn O'Shea
  • UK Medical News
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Delaying or withholding antibiotics for patients over 65 with symptoms of urinary tract infection (UTI) appears to be associated with higher risk for sepsis and death, finds a study published by the BMJ.

The findings suggest that older adults, especially men aged above 85 years, should start taking antibiotics as soon as possible after diagnosis to prevent serious complications.

The retrospective population-based cohort study linked Clinical Practice Research Datalink (2007-2015) primary care records and hospital episode statistics and death records in England to identify 1,57,264 adults aged 65 years or older presenting to a general practitioner (GP) with at least one diagnosis of suspected or confirmed lower UTI from November 2007 to May 2015.

The data showed that 1539 episodes of sepsis (0.5%) were recorded within 60 days after the initial UTI. The rate was significantly higher among patients not prescribed an antibiotic (2.9%) and those recorded as revisiting the GP within 7 days of initial consultation for an antibiotic prescription compared with those given a prescription at the initial consultation (2.2 v 0.2%; P=.001).

After adjustment for covariates, the risk for sepsis was significantly higher with deferred antibiotics (adjusted odds ratio [OR], 7.12; 95% CI, 6.22-8.14) and no antibiotics (aOR, 8.08; 95% CI, 7.12-9.16) compared with immediate antibiotics.

The risk for all-cause mortality was significantly higher with deferred antibiotics (adjusted hazard ratio [HR], 1.16; 95% CI, 1.06-1.27) and no antibiotics (HR, 2.18; 95% CI, 2.04-2.33) than with immediate antibiotics at any time during the 60 days of follow-up. Men older than 85 years were particularly at risk for both sepsis and 60-day all-cause mortality.

“In the context of an increase of Escherichia coli bloodstream infections in England, early initiation of recommended first-line antibiotics for UTI in the older population is advocated,” say the study authors.