As Nurses we are aware of the incidence of urinary tract infections in the elderly. However you may not be aware of this study which identifies that delaying the commencement of antibiotics in the elderly may have significant  adverse outcomes. The following is from a recent edition of General Practice Research Review and the study reviewed is titled Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality Authors: Gharbi M et al.


This retrospective cohort study in the UK evaluated the association between antibiotic treatment of UTIs and severe adverse outcomes in elderly patients in primary care. Medical records were reviewed for 157,264 adults aged ≥65 years who presented to a GP with a UTI in 2007–2015. Among 312,896 UTI episodes in 157,264 patients, 7.2% did not have a record of antibiotics being prescribed and 6.2% had a delay in antibiotic prescribing. 1539 episodes of bloodstream infection (0.5%) were recorded within 60 days after the initial UTI. After adjustment for covariates, patients were significantly more likely to have a bloodstream infection if they received a deferred antibiotic (adjusted odds ratio, 7.12) or no antibiotic (8.08) compared with those given an antibiotic at the first consultation.

The rate of hospital admissions in patients with no antibiotics or deferred antibiotics was approximately double that in patients prescribed immediate antibiotics (27.0% and 26.8% vs 14.8%; p=0.001). The risk of all-cause mortality was significantly higher with deferred antibiotics and no antibiotics than with immediate antibiotics.

Comment(GG): Traditionally GPs are told to delay antibiotics in UTIs until the sensitivities of the organism are known. This large observational study shows that, in the elderly, delay in initiating antibiotics is associated with serious consequences. We have no evidence that this is a problem in women with UTIs in their childbearing years who are more commonly seen by GPs.

Reference: BMJ 2019;364:l525  Access full article here>>

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