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Delaying antibiotics in over 65s with UTI ups sepsis risk

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Delaying or withholding antibiotics for over 65s with symptoms of a urinary tract infection (UTI) appears to be associated with higher risk of sepsis and death, according to UK researchers.

Their findings, in the British Medical Journal, suggest that older adults, especially men over 85, should start taking antibiotics as soon as possible after diagnosis to prevent serious complications.

The researchers noted that UTI was the most common bacterial infection in older patients but concerns about the spread of antibiotic resistance had led to reductions in antibiotic use in England.

They warned that a decline in antibiotic use may harm vulnerable older patients who were already more likely to develop UTI-related complications.

The study authors, from London and Oxford, set out to assess approaches to antibiotic prescribing and subsequent clinical outcomes in older 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, 79% of cases were female and follow-up was for 60 days after diagnosis.

The researchers then compared outcomes for the 87% of patients prescribed immediate antibiotics, the 6% who had deferred antibiotics – prescription within seven days – and the 7% who had none.

Bloodstream infections and mortality rates were found to be significantly higher in the groups with no and with deferred prescriptions, compared with immediate scripts.

The researchers calculated that, on average, for every 37 patients not given antibiotics and for every 51 whose 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%).

University of Bristol

Uncertainty a factor in prescribing antibiotics for children

Alastair Hay

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

They said their findings suggested 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 was needed for the management of older men, and those in deprived communities, they added.

In a linked editorial in the BMJ, Professor Alastair Hay, a primary care researcher at the University of Bristol, agreed that prompt treatment should be offered to older patients.

Further research was 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”, he said.

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