Takeaway
- Delaying or withholding antibiotics for suspected lower urinary tract infection (UTI) did not increase the risk of bloodstream infection (BSI) in adults aged ≥65 years.
- However, the risk of mortality was increased in the subsequent 60 days.
Why this matters
- Findings highlight the need for novel diagnostic and/or risk prediction strategies to guide antibiotic-prescribing decisions for suspected UTI.
Study design
- This population-based study included 147,334 patients (aged, ≥65 years) with 280,462 distinct episodes of lower UTI using data from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics and census data (2007-2015).
- Primary outcome: BSI within 60 days of UTI episodes, comparing patients treated immediately with antibiotics and those not treated immediately.
- Funding: Economic and Social Research Council and Health Data Research UK.
Key results
- BSI occurred in 0.4% (1025/244,963) of UTI episodes treated with immediate antibiotics vs 0.6% (228/35,499) of episodes without immediate antibiotics.
- Delaying or withholding antibiotic treatment showed no statistically significant association with an increased likelihood of BSI in the following 60 days (adjusted OR [aOR], 1.13; 95% CI, 0.97-1.32; P=.105).
- Women were less likely to develop BSI than men (aOR, 0.49; 95% CI, 0.43-0.55; P<.001).
- Increasing age (aOR, 1.22; 95% CI, 1.18-1.27 per 5 years; P<.001) and social deprivation (aOR, 1.45; 95% CI, 1.19-1.76; P<.001) were independently associated with BSI.
- Delaying or withholding antibiotics treatment was associated with an increased risk of mortality in the subsequent 60 days (aOR, 1.17; 95% CI, 1.09-1.26; P<.001); however, there was limited evidence that increased mortality was attributable to urinary-source BSI.
Limitations
- Risk of residual confounding.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
