Early antibiotics treatment improves outcome for elderly patients with UTIs

Posted: 06/03/2019

A recent study published by researchers at Imperial College London in the British Medical Journal has highlighted the importance of timely use of antibiotics treatment in elderly patients diagnosed with a urinary tract infection (UTI).

UTIs can affect different parts of the urinary tract, including the bladder, urethra or kidney.  Patients may experience symptoms such as pain or burning on urination, fatigue and generally feeling unwell. Some older patients may become agitated and confused. UTIs are more prevalent in the elderly, and in fact they represent the most frequent bacterial infection within this age group. When left untreated, UTIs can lead to blood poisoning, sepsis, and in some cases can be fatal. The incidence of sepsis and death increases disproportionately with age.  

UTIs are the second most common condition for which antibiotics are prescribed in the UK. As a result of pressure on doctors to curb unnecessary prescriptions of antibiotics, there has however been a recent decrease in prescriptions for UTIs in elderly patients.

Due to the potential harm that could be caused to these patients, researchers at Imperial College London set about gathering data on the initial treatment and management of UTIs in people over 65 to study the outcomes in detail.

They analysed records of 157,264 patients in England who had been diagnosed with a confirmed or suspected UTI and made the following findings:

• among those patients who were given antibiotics immediately on diagnosis, only 0.2% went on to develop sepsis;
• patients given delayed antibiotics or no antibiotics at all were found to be eight times more likely to develop sepsis;
• the risk of death for patients with delayed antibiotics increased by 16%, and for patients given no antibiotics this risk rose to 50%;
• the rate of hospital admissions almost doubled for patients given delayed antibiotics or no antibiotics compared to patients given immediate antibiotics.

These findings suggest that GPs should consider the immediate prescription of antibiotics for elderly patients diagnosed with UTIs to mitigate the risk of serious adverse outcomes, despite pressure to reduce unnecessary antibiotics usage.

Rosie Nelson, an associate in the clinical negligence team at Penningtons Manches, said: “Although doctors are under pressure to avoid over-prescribing antibiotics, greater consideration must be given in the case of elderly people with urinary infections who are most at risk of adverse and fatal outcomes. Hopefully the study will go some way to protecting this more vulnerable group of patients.”

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