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The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults.

Authors :
Langford, Bradley J
Brown, Kevin A
Diong, Christina
Marchand-Austin, Alex
Adomako, Kwaku
Saedi, Arezou
Schwartz, Kevin L
Johnstone, Jennie
MacFadden, Derek R
Matukas, Larissa M
Patel, Samir N
Garber, Gary
Daneman, Nick
Source :
Clinical Infectious Diseases; Aug2021, Vol. 73 Issue 3, pe782-e791, 10p
Publication Year :
2021

Abstract

Background The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults. Methods We conducted a matched cohort study comparing older adults (≥66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for ≥30 days starting within 30 days of a positive culture, with patients with positive urine cultures who received antibiotic treatment but did not receive prophylaxis. We matched each prophylaxis recipient to 10 nonrecipients based on organism, number of positive cultures, and propensity score. Outcomes included (1) emergency department (ED) visit or hospitalization for UTI, sepsis, or bloodstream infection within 1 year; (2) acquisition of antibiotic resistance in urinary tract pathogens; and (3) antibiotic-related complications. Results Overall, 4.7% (151/3190) of UTI prophylaxis patients and 3.6% (n = 1092/30 542) of controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12–1.57). Acquisition of antibiotic resistance to any urinary antibiotic (HR, 1.31; 95% CI, 1.18–1.44) and to the specific prophylaxis agent (HR, 2.01; 95% CI, 1.80–2.24) was higher in patients receiving prophylaxis. While the overall risk of antibiotic-related complications was similar between groups (HR, 1.08; 95% CI,.94–1.22), the risk of Clostridioides difficile and general medication adverse events was higher in prophylaxis recipients (HR [95% CI], 1.56 [1.05–2.23] and 1.62 [1.11–2.29], respectively). Conclusions Among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10584838
Volume :
73
Issue :
3
Database :
Complementary Index
Journal :
Clinical Infectious Diseases
Publication Type :
Academic Journal
Accession number :
151699103
Full Text :
https://doi.org/10.1093/cid/ciab116