Long-term preventive treatment of urinary tract infection with antibiotics (UTI) is associated with an increased risk of antibiotic resistance, hospitalization or emergency department visits, bloodstream infection, and sepsis among older adults age 66 or older, according to a retrospective study published in Clinical infectious diseases.
The investigators considered that patients were undergoing prophylaxis for UTIs if they received any antibiotic, except doxycycline, for 30 days or longer, which was initiated within 30 days after a positive urine culture. The study authors obtained data on 186,589 patients who had a positive primary urine culture and received antibiotics through ICES, formerly known as the Institute for Clinical Evaluative Sciences. Of these patients, 3,198 (1.0%) received antibiotic prophylaxis with a mean antibiotic duration of 49 days (spring term, 30-94 days). Patients receiving prophylaxis were more likely to be men, who lived in a community environment, the number of hospital visits and positive urine cultures increased.
The most common antibiotic protective agents were nitrofurantoin (n = 1401; 44.0%), trimethoprim / sulfamethoxazole (n = 542; 17.0%), ciprofloxacin (n = 500; 15.7%), cephalexin (5.9%), and trimethoprim (4.8). %).
The primary efficacy outcome was as a compound from an emergency department visit or hospitalization for a UTI, bloodstream infection, or sepsis within 30 days to one year after a positive culture. The sensitivity analysis performed, which limited protective factors to those most likely to be indicated in UTI, revealed that the risk of these outcomes consistently occurs in patients (risk ratio). [HR], 1.29; 95% CI, 1.06-1.54).
The investigators also indicated that the primary outcome of the damage was the discovery of repeated urinary isolates resistant to any antibiotic to which the first culture was sensitive.
A total of 431 prophylactic recipients (20.9%) and 3,218 patients in the control group (16.4%) developed resistance to any factor (HR, 1.31; 95% CI, 1.18-1.44). In addition, antibiotic-related harm was seen in 243 prophylactic recipients (7.6%) and 2,169 patients in the control group (7.1%; HR, 1.08; 95% CI, 0.94-1.22), including Clostridioids Difficult Infections (HR, 1.56; 95% CI, 1.05-2.23) and general factor-related adverse events (HR, 1.62; 95% CI, 1.11-2.29). Sensitivity analysis showed a continuous development of resistance to factors in the patients (HR, 1.31; 95% CI, 1.17-1.45).
This study found no clinical benefit for antibiotic prophylaxis of UTIs among the elderly. However, it has been shown to increase the risk of harm associated with prevention, most notably the development of antibiotic resistance. Limitations included the inability to distinguish true UTIs from asymptomatic bacteriuria in vitro and administrative data collected.
The study authors concluded that “our findings may help shed light on some of the risks of preventing UTI in the elderly, which may change the doctor’s understanding of the ratio between benefits and harms in this population.”
Langford PJ, Brown CA, Diong C, et al. Benefits and harms of antibiotic prophylaxis for urinary tract infection in the elderly. Clen infect dis. Posted online February 17, 2021. doi: 10.1093 / cid / ciab116