Urinary tract infection (UTI) is the most common bacterial infection in the elderly population, and Escherichia coli is the most common uropathogen in people in the community over 65 years of age. The spectrum of UTI varies from a self-limiting disease leading to severe sepsis, with a mortality rate of 20-40%.
The diagnosis of UTI in elderly patients can be problematic, since patients are less likely to present a typical clinical history and localized urinary symptoms compared to younger patients. In a new study from Imperial College London, scientists suggest that the immediate prescription of antibiotics for elderly patients with urinary tract infections is associated with a reduced risk of sepsis and death.
This finding provides more evidence to help GPs make clinical decisions about when to immediately prescribe antibiotics for urinary tract infections (UTIs) and when to delay treatment to see if symptoms improve on their own to avoid overuse of antibiotics.
The scientists looked at records of 157,264 patients over 65 years of age across England who had been diagnosed by their doctor with suspected or confirmed urinary tract infection.
Patients had been given antibiotics immediately (87% of the cases examined on the farm), had antibiotics delayed within 7 days (6% of cases) or received no antimicrobial at any stretch of the imagination (7% of cases).
Of the patients who received antibiotics immediately, 0.2% developed sepsis in the next 60 days. After taking into account the available information on differences in age, sex, preexisting disease and other personal characteristics, the results revealed that, in comparison with patients who received antibiotics immediately, patients who had antibiotic prescription delayed or did not receive antibiotics eight times more likely to develop sepsis.
Nearly 1.6 percent of patients who received antibiotics died immediately in the next 60 days. This means that the risk of death during the same period among patients who had their antibiotic delayed prescription showed a slight increase (16%), while patients who did not receive antibiotics had more than double the risk.
The researchers estimated that, on average, for every 37 patients exposed to no antibiotic and for every 51 patients exposed to deferred antibiotics, a case of sepsis would occur that would not have been observed with immediate antibiotics.
They also found that the rate of hospital admissions practically doubled (27%) in patients with no or no prescription of deferred antibiotics compared to those who received immediate prescriptions (15%).
Older men, especially those over 85, and those living in poorer areas were considered at greater risk.
The researchers emphasize that this study only shows that delayed antibiotics are associated with an increased risk of sepsis and death, rather than directly causing it. They add that patients may also have other health conditions that the researchers were unable to explain, which may have contributed to the increased risk of sepsis or death.
Principal author Myriam Gharbi of the Imperial School of Public Health said: "The current national guidelines for GPs recommend that patients be asked about the severity of their symptoms, discuss possible self-care, how to drink plenty of water to avoid dehydration, and take paracetamol or ibuprofen for pain relief and consider a prescription antibiotic prescription to be used if the symptoms worsen or do not improve after 48 hours. This is to avoid overuse of antibiotics, as sometimes UTIs can improve without medication. However, our research suggests that antibiotics should not be delayed in elderly patients. "
The scientists also studied data from 157, 264 patients aged 65 years or over diagnosed with UTIs or suspected UTIs to help clarify when antibiotics should be prescribed. Data were from the Clinical Practice Research Datalink, which uses anonymous patient data from both GP practices related to hospital data, allowing the same patients to be screened between the two settings. The mean age of the patients in the study was 77 years.
Professor Paul Aylin, senior author of the NIHR Health Protection Unit research at Imperial, said, "While antibiotic prescription should be controlled to help address the growing problem of antibiotic resistance, our study suggests that early use of antibiotics in elderly patients with UTIs is the safest approach. "
Professor Alan Johnson of Public Health England, who helped with the research, said: "Resistance to antibiotics is a major public health threat that is being driven by overuse of antibiotics. Current recommendations suggest that health care professionals take into account several factors when deciding whether to prescribe antibiotics immediately or whether to consider postponing antibiotics to patients suspected of having a urinary tract infection. "
"This study highlights the importance of taking age into account when making clinical decisions about prescribing antibiotics in order to reduce the risk of complications. This work will help doctors target the use of antibiotics more effectively and improve patient well-being. "
The research is published in the journal BMJ.