Background: If left untreated, UTIs may lead to severe complications. Although campaigns aimed at decreasing unnecessary prescriptions have reduced the number of antibiotic prescriptions for UTI, a concurrent rise in the rates of gram-negative bloodstream infections (BSIs) has also been observed.
Study design: Retrospective, population-based cohort study with data compiled from primary care records from 2007 to 2015 linked to hospital episode statistics and death records.
Setting: General practices in England.
Synopsis: The investigators analyzed 312,896 UTI episodes among 157,264 unique patients (65 years of age or older) during the study period. Exclusion criteria included asymptomatic bacteriuria and complicated UTI. Of 271,070 patients who received antibiotics on the day of presentation with symptoms, 0.2% developed BSI within 60 days versus 2.2% of patients in whom antibiotics were delayed and 2.9% among patients not prescribed antibiotics. After adjustment for comorbidities, sex, and socioeconomic status, patients in whom antibiotics were deferred had a 7.12-fold greater odds of BSI, compared with the immediate-antibiotic group. BSIs were more common among men and older patients. All-cause mortality, a secondary outcome, was 1.16-fold higher with deferred antibiotics and 2.18 times higher with no antibiotics.
While the cohort studied was very large, a causal relationship cannot be firmly established in this observational study. Also, researchers were unable to include laboratory data, such as urinalysis and culture, in their analysis.
Bottom line: Delayed prescription of antibiotics for elderly patients presenting with UTI in primary care settings was associated with higher rates of BSI and death.
Citation: Gharbi M et al. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all-cause mortality: Population-based cohort study. BMJ. 2019 Feb;364:1525.
Dr. Torres is a hospitalist at Massachusetts General Hospital.