Delaying or withholding antibiotics in patients aged over 65 years with symptoms of urinary tract infection (UTI) is associated with a higher risk of sepsis and death, suggests a study published in the BMJ.
The retrospective population-based cohort study examined the records of 157,264 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 main outcome measures were bloodstream infection, hospital admission, and all-cause mortality within 60 days after the index UTI diagnosis.
The rate of bloodstream infection was significantly higher among patients not prescribed an antibiotic (2.9%; n=647) and those recorded as revisiting the GP within seven days of the initial consultation for an antibiotic prescription compared with those given a prescription for an antibiotic at the initial consultation (2.2% vs 0.2%; P=0.001).
The rate of hospital admissions was about double among cases with no antibiotics (27.0%) and deferred antibiotics (26.8%) compared with those prescribed immediate antibiotics (14.8%; P=0.001).
The risk of all-cause mortality was significantly higher with deferred antibiotics and no antibiotics than with immediate antibiotics at any time during the 60 days follow-up (adjusted hazard ratio 1.16, 95% CI 1.06 to 1.27 and 2.18, 2.04 to 2.33, respectively).
Men older than 85 years were particularly at risk for both bloodstream infection 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 by the researchers.