Prompt UTI Antibiotics Cut Mortality, Sepsis Risk in Older Adults

A study published in the BMJ found persons older than 65 with urinary tract infections (UTIs) are at higher risk for sepsis and death within 60 days if not treated with antibiotics immediately. Those older than 85 are especially in danger if antibiotics are deferred or not prescribed, reports Medscape . "Particular care is needed for the management of older men and those in deprived communities," said Imperial College London's Myriam Gharbi. The team investigated data from the National Health Service Clinical Practice Research Datalink on more than 150,000 individuals 65 or older who had presented to a general practitioner with at least one case of suspected or confirmed lower UTI from November 2007 to June 2015. More than 300,000 UTI cases were diagnosed, with most suspected on the basis of clinical symptoms because real-time microbiology analysis is largely unavailable in primary care in Britain. Of that cohort, 86.6 percent received an antibiotic prescription at the initial consultation, 6.2 percent received antibiotics after a weeklong delay, and 7.2 percent were not given antibiotics. Those older than 85 were much less likely than those 65 to 74 to receive antibiotics immediately. The risk of developing sepsis within 60 days was seven times higher for persons who received no antibiotics versus those treated immediately and sixfold higher for those whose antibiotic treatment was delayed. Finally, all-cause mortality within 60 days of index UTI diagnosis was 2.18 times higher for the no-antibiotic group and 1.16 times higher for the deferred-antibiotic group compare to the immediate-treatment group.