In elderly patients with urinary tract infections, delayed use of antibiotics is associated with sepsis and death
Urinary tract infection (UTI) is the most common bacterial infection in the elderly population, and Escherichia coli is the most common uropathy in people over 65 years of age.
UI spectrum differs from mild self-limiting disease to severe sepsis, with a mortality rate of 20-40%.
Sepsis frequency and associated mortality increase disproportionately to age, and UI more often for men be serious Both sexes in the elderly develop UI, but the ratio between women and men is 2: 1 in patients over 70 years of age, compared with the highest susceptibility to urinary tract infections in 50: 1 younger women.
Diagnosis of UTI in elderly patients may be problematic as these patients they are not present characterized by clinical history and localized urinary symptoms compared to younger patients. Increasing incidence Asymptomatic bacteriuria for older adults, it also contributes to greater diagnostic difficulties (> 20% for women over 65 years of age compared to <5% for younger women), leading to excessive diagnosis of UTI and unnecessary treatment.
UTI is the second most common diagnosis for which empirical antibiotics are intended for both primary and secondary care and is considered to be unnecessarily more than 50% of antibiotics for suspected UTIs in older adults.
With the spread and increase of antibiotic resistance, it was proposed to endanger public health (about 30% of E. coli urinary isolates are resistant to trimethoprim), national guidelines and antimicrobial use programs to combat these problems.
For example, NHS England launched a Quality Supplement to encourage the Clinical Panel Commission to reduce the use of antibiotics in primary care. As a result of these new initiatives, significant reductions in antibiotic use in England have been reported throughout the health care system from 2013 to 2017.
A recent study also shows that older people have reduced the range of antibiotics in primary care between 2004 and 2014. Increased incidence of gram-negative infections in the bloodstream, which has notified the UK government of a plan to reduce by 50% by 2021 health-related blood infections in England.
According to a retrospective study by BMJ, inhibition of antibiotics in elderly people with urinary tract infections may increase the risk of sepsis and death.
Researchers from the US UU They tested medical data for 157,000 adults over the age of 65 who were diagnosed with primary care with at least one UTI.
Approximately 313,000 uncomplicated, suspicious or confirmed UTIs were included: antibiotics were immediately prescribed at 87%, delayed, but signed at 6% a week and not set at 7%.
Blood circulation and mortality rates were significantly higher in 60 days when antibiotics were delayed or not prescribed than when they were taken immediately.
In particular, researchers estimate that the rate of infection would be exceeded in each of the 37 untreated patients and 51 in the bloodstream, and that each of 27 untreated patients and every 83 patients who received treatment would have died. they received delayed treatment.
The editor admits that the link between delayed antibiotics and the worst results may not be causal, but nevertheless he and the authors support the rapid treatment of these patient populations.
Infectious Disease Specialist, Dr. Paul Sax, commenting: "This study describes the" coin of the other party "for doctors who want to avoid over-asymptomatic treatment of bacteriuria in the elderly, which is that inadequate treatment for symptomatic infection can have serious consequences.
Practical difficulties in assessing UI symptoms (especially those with cognitive impairment) remain a major challenge. "
The risk of circulatory infections and all-cause mortality has also increased in men and elderly patients, especially those over 85 years of age and those living in disadvantaged areas.
Patients treated with an immediate antibiotic for the UI episode experienced a small but significant increase in survival in patients treated for 60 days. nitrofurantoin compared to trimethoprim. This increase could reflect a higher level of resistance to trimethoprim or a healthier population treated with nitrofurantoin; the latter is not recommended for patients with kidney problems.
These results are consistent with the recent cohort study using Datalink Clinical Practice Research (CPRD) data, where nitrofurantoin this was due to lower probability of death within 14 days of antibiotic induction for all investigated antibiotics.
Kaplan-Meier survival curves for 60 days with antibiotics
Clinical, policy and research implications
Our results show that primary care doctors believe that early antibiotic recipes this vulnerable group of older adults, given their increased susceptibility to sepsis after UTI, and despite increasing pressure to reduce antibiotic inappropriate use.
Particular care should be taken to manage older men and disadvantaged communities. Researchers need to improve their understanding of the impact of delayed antibiotic prescription in everyday practice. Therefore, in order to record when primary care doctors recommend patients to delay the use of antibiotics, new medical records or regenerative codes should be created.
The results of this large population study show: a the risk of circulatory infections and mortality increases significantly for all causes and hospital admission rates associated with non-antibiotics and deferred antibiotics compared to immediate antibiotics for older adults diagnosed with UTI in primary care.
Our study shows that It is recommended to start antibiotics early UTI for high risk elderly adults (especially men over 85 years) to prevent serious complications.
What is already known about this topic
This study adds