Urinary tract infection (UTI) is the most common bacterial infection in elderly patients, and the spectrum of illness ranges from mild and self-limiting to severe urosepsis. More evidence is needed to determine the ideal initial management of UTI in the primary care setting. In this retrospective cohort study, 312,896 UTI episodes from 157,264 unique patients age 65 years or older were studied to assess the impact of antibiotic prescribing practices on bloodstream infections, hospital admission, and all-cause mortality within 60 days after the index UTI diagnosis. The mean age of the study cohort was 76.7 years, and at the time of initial UTI diagnosis, 78.8% of participants were women, 40.3% originated from the south of England, and 28.9% were from the most deprived areas. Immediate antibiotic prescribing was defined as prescription of an antibiotic during the first UTI visit or on the same day, and deferred antibiotic prescribing was defined as prescription of an antibiotic within 7 days of the first UTI visit. Among all UTI episodes, 7.2% did not have a record of antibiotics being prescribed, and in 6.2%, there was deferred antibiotic prescribing. After adjusting for covariates, researchers found that the rate of bloodstream infection within 60 days was significantly higher among patients who were not prescribed an antibiotic compared with those who received immediate antibiotic treatment (2.9% vs. 0.2%, OR 8.08, 95% CI 7.12 to 9.16, p<0.001), and was also higher among patients who received a deferred antibiotic prescription (2.2% vs. 0.2%, OR 7.12, 95% CI 6.22 to 8.14, p<0.001). Additionally, the rate of hospital admissions was significantly higher in cases that did not receive antibiotics (27.0%) or received deferred antibiotics (26.8%) compared to those that received immediate antibiotics (14.8%, p<0.001). Finally, the risk of all-cause mortality was significantly higher in cases with no antibiotics and with deferred antibiotics than in those with immediate antibiotics during the 60-day follow-up period (HR 2.18, 95% CI 2.04 to 2.33 and HR 1.16, 95% CI 1.06 to 1.27, respectively). Overall, this study supports immediate initiation of antibiotics in elderly patients with a diagnosis of UTI.
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