Bradley J Langford1,2, Kevin A Brown3, Christina Diong4, Alex Marchand-Austin4, Kwaku Adomako1, Arezou Saedi1, Kevin L Schwartz3, Jennie Johnstone5, Derek R MacFadden6, Larissa M Matukas7, Samir N Patel8, Gary Garber9,10, Nick Daneman11. 1. Public Health Ontario, Toronto, Ontario, Canada. 2. Hotel Dieu Shaver Health and Rehabilitation Centre, St Catharines, Ontario, Canada. 3. Public Health Ontario, ICES, Dalla Lana School of Public Health, Toronto, Ontario, Canada. 4. ICES, Toronto, Ontario, Canada. 5. Public Health Ontario, Sinai Health, Dalla Lana School of Public Health, Toronto, Ontario, Canada. 6. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 7. Unity Health Toronto, University of Toronto Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada. 8. Public Health Ontario, University of Toronto Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada. 9. Public Health Ontario, University of Toronto, Toronto, Ontario, Canada. 10. Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 11. Public Health Ontario, Sunnybrook Health Sciences Center, ICES, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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 Clostridioidesdifficile 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. Her Majesty the Queen in Right of Canada, as represented by the Public Health Ontario, 2021.
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 Clostridioidesdifficile 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. Her Majesty the Queen in Right of Canada, as represented by the Public Health Ontario, 2021.
Authors: Chris Harding; Helen Mossop; Tara Homer; Thomas Chadwick; William King; Sonya Carnell; Jan Lecouturier; Alaa Abouhajar; Luke Vale; Gillian Watson; Rebecca Forbes; Stephanie Currer; Robert Pickard; Ian Eardley; Ian Pearce; Nikesh Thiruchelvam; Karen Guerrero; Katherine Walton; Zahid Hussain; Henry Lazarowicz; Ased Ali Journal: BMJ Date: 2022-03-09
Authors: Natalia Krzyzaniak; Connor Forbes; Justin Clark; Anna Mae Scott; Chris Del Mar; Mina Bakhit Journal: Br J Gen Pract Date: 2022-05-06 Impact factor: 6.302