Harms of UTI prophylaxis outweigh benefits in older adults
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Older adult patients who received antibiotic prophylaxis for UTIs experienced an increased risk for hospitalization, sepsis and bloodstream infection, according to a study in Clinical Infectious Diseases.

The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. This study sought to quantify the benefits and risks of antibiotic prophylaxis among older adults.

Researchers conducted a matched cohort study comparing older adults (more than 66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for at least 30 days starting within 30 days of a positive culture, to patients with positive urine cultures that received antibiotic treatment but did not receive prophylaxis. They matched each prophylaxis recipient to 10 non-recipients 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; 3) antibiotic-related complications.

Results:
-- Overall 4.7% (151/3,190) of UTI prophylaxis patients and 3.6% (n=1,092/30,542) controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection.

-- Acquisition of antibiotic resistance to any urinary antibiotic and to the specific prophylaxis agent were higher in patients receiving prophylaxis.

-- While the overall risk of antibiotic-related complications was similar between groups, the risk of C. difficile and general medication adverse events was higher in prophylaxis recipients.

Conclusively, among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits.

Source: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab116/6141409
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