Nav: Home

Delaying or withholding antibiotics for over-65s with urinary infection linked to sepsis

February 27, 2019

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

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

Urinary tract infection (UTI) is the most common bacterial infection in older patients. But concerns about the spread of antibiotic resistance have led to reductions in antibiotic use in England.

Such a decline in antibiotic use, however, may harm vulnerable older patients who are already more likely to develop UTI-related complications, and there is a lack of good evidence about the treatment of UTIs in primary care.

So a team of UK researchers set out to assess approaches to antibiotic prescribing and subsequent clinical outcomes in elderly patients.

They used primary care data linked to hospital and mortality records across England to analyse over 300,000 UTIs among more than 150,000 patients aged 65 years or older between 2007 and 2015.

The average age of participants was 77 years, most (79%) cases were female, and follow-up was for 60 days after diagnosis.

The researchers then compared outcomes for the 87% of patients who were prescribed immediate antibiotics (on the day of diagnosis), the 6% who had deferred antibiotics (prescription within seven days), and the 7% who had no antibiotics (no record of a prescription within seven days).

After taking account of potentially influential factors, bloodstream infections and mortality rates were significantly higher in the groups with no and with deferred prescriptions, compared with immediate prescriptions

The researchers estimate that on average for every 37 patients not given antibiotics and for every 51 patients whose antibiotic treatment was deferred, one case of sepsis would occur that would not have been seen with immediate antibiotics.

They also found that the rate of hospital admissions was around double (27%) in patients with no and with deferred prescriptions, compared with immediate prescriptions (15%).

Older men, especially those aged over 85 years, and those living in more deprived areas were most at risk.

This is an observational study, and as such, can't establish cause, and the researchers cannot rule out the possibility that unmeasured factors or missing data may have affected the results.

Nevertheless, they say their findings suggest that GPs "consider early prescription of antibiotics for this vulnerable group of older adults, in view of their increased susceptibility to sepsis following UTI and despite a growing pressure to reduce inappropriate antibiotic use."

Particular care is needed for the management of older men, and those in deprived communities, they conclude.

In a linked editorial, Alastair Hay at the University of Bristol says the implications of this study "are likely to be more nuanced than primary care doctors risking the health of older adults to meet targets for antimicrobial stewardship."

However, he agrees that prompt treatment should be offered to older patients, especially men and those living in areas of greater socioeconomic deprivation, and says further research is needed "to establish whether treatment should be initiated with a broad or a narrow spectrum antibiotic and to identify those in whom delaying treatment (while awaiting investigation) is safe."
-end-


BMJ

Related Antibiotics Articles:

Antibiotics: City dwellers and children take the most
City dwellers take more antibiotics than people in rural areas; children and the elderly use them more often than middle-aged people; the use of antibiotics decreases as education increases, but only in rich countries: These are three of the more striking trends identified by researchers of the NRW Forschungskolleg ''One Health and Urban Transformation'' at the University of Bonn.
Metals could be the link to new antibiotics
Compounds containing metals could hold the key to the next generation of antibiotics to combat the growing threat of global antibiotic resistance.
Antibiotics from the sea
The team led by Prof. Christian Jogler of Friedrich Schiller University, Jena, has succeeded in cultivating several dozen marine bacteria in the laboratory -- bacteria that had previously been paid little attention.
Antibiotics not necessary for most toothaches, according to new ADA guideline
The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches.
Antibiotics with novel mechanism of action discovered
Many life-threatening bacteria are becoming increasingly resistant to existing antibiotics.
Resistance can spread even without the use of antibiotics
Antibiotic resistance does not spread only where and when antibiotics are used in large quantities, ETH researchers conclude from laboratory experiments.
Selective antibiotics following nature's example
Chemists from Konstanz develop selective agents to combat infectious diseases -- based on the structures of natural products
Antibiotics can inhibit skin lymphoma
New research from the LEO Foundation Skin Immunology Research Center at the University of Copenhagen shows, surprisingly, that antibiotics inhibit cancer in the skin in patients with rare type of lymphoma.
Antibiotics may treat endometriosis
Researchers at Washington University School of Medicine in St. Louis have found that treating mice with an antibiotic reduces the size of lesions caused by endometriosis.
How antibiotics help spread resistance
Bacteria can become insensitive to antibiotics by picking up resistance genes from the environment.
More Antibiotics News and Antibiotics Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.