1. Delaying antibiotic treatment for UTI in older adults did not increase risk of bloodstream infection compared to immediate antibiotic treatment.
2. Delayed treatment may have contributed to increased risk of mortality in this group.
Evidence Rating Level: 3 (Average)
Urinary tract infection (UTIs) is one of the most common reasons for antibiotic prescription, which is frequently caused by the Escherichia coli (E. coli) pathogen. The rate of E. coli bloodstream infection (BSI) is highest in older adults. Clinically, the safety of delaying treatment among this population with suspected UTI has been questioned. This retrospective study aimed to investigate the relationship between antibiotic timing for UTI treatment and risk of BSI using the nationally representative, United Kingdom Clinical Practice Research Datalink database. Included participants were aged 65 years or older between April 1, 2007 and March 31, 2015, with a minimum of 60 days of follow-up. A total of 280,562 people were included in the final dataset (Med [IQR] age = 77.3 [71.1 to 83.9] years, 77.5% female). This study discovered that delaying antibiotic treatment for UTI did not increase risk of BSI but there was some evidence that it may result in increased mortality. Compared to men, women were more likely to develop BSI (adjusted OR 0.49, 9% CI 0.43 to 0.55, p<0.001). BSI was independently associated with both social deprivation (adjusted OR 1.45, 95% CI 1.19 to 1.76, p<0.001) and increasing age (adjusted OR 1.22, 95% CI 1.18 to 1.27 per 5 years, p<0.001). Analyses suggested that there were differences between those who received immediate antibiotic treatment and those whose treatment was delayed, which are likely due to confounding. Overall, this study suggests that delaying antibiotic treatment for suspected UTI in older adults may increase the risk of mortality without demonstrating sufficient advantages over immediate treatment.
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