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

被引:35
作者
Langford, Bradley J. [1 ,2 ]
Brown, Kevin A. [3 ]
Diong, Christina [4 ]
Marchand-Austin, Alex [4 ]
Adomako, Kwaku [1 ]
Saedi, Arezou [1 ]
Schwartz, Kevin L. [3 ]
Johnstone, Jennie [5 ]
MacFadden, Derek R. [6 ]
Matukas, Larissa M. [7 ]
Patel, Samir N. [8 ]
Garber, Gary [9 ,10 ]
Daneman, Nick [11 ]
机构
[1] Publ Hlth Ontario, 480 Univ, Toronto, ON M5G 1V2, Canada
[2] Hop Hotel Dieu, Shaver Hlth & Rehabil Ctr, St Catharines, ON, Canada
[3] Publ Hlth Ontario, ICES, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
[4] ICES, Toronto, ON, Canada
[5] Publ Hlth Ontario, Sinai Hlth, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
[6] Ottawa Hosp Res Inst, Ottawa, ON, Canada
[7] Univ Toronto, Unity Hlth Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada
[8] Univ Toronto, Publ Hlth Ontario, Dept Lab Med & Pathobiol, Toronto, ON, Canada
[9] Univ Toronto, Publ Hlth Ontario, Toronto, ON, Canada
[10] Univ Ottawa, Ottawa Hosp Res Inst, Dept Med, Ottawa, ON, Canada
[11] Univ Toronto, Sunnybrook Hlth Sci Ctr, Inst Hlth Policy Management & Evaluat, ICES,Publ Hlth Ontario, Toronto, ON, Canada
基金
加拿大健康研究院;
关键词
urinary tract infection; older adults; antimicrobial prophylaxis; ASYMPTOMATIC BACTERIURIA; RISK-FACTORS; ASSOCIATION; GUIDELINES; MANAGEMENT;
D O I
10.1093/cid/ciab116
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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.
引用
收藏
页码:E782 / E791
页数:10
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