Urinary tract infections (UTIs), also known as 'bladder infections' or 'cystitis', are a common cause of illness in older people. Older people with symptoms of a UTI usually see their GP and may need antibiotics. Although some GPs wait for results of a urine test (48-72 hours) before prescribing antibiotics, most will prescribe at the initial consultation based on presenting signs and symptoms. Little is known about the rates of adverse outcomes in older people managed in this way, for example, rates receiving an alternative antibiotic because of persisting symptoms, of hospitalisation for serious infection, or of sudden worsening of kidney function. There is a need for research that estimates the risk of these outcomes for different antibiotics and different durations of treatment, to help GPs make informed decisions around immediate antibiotic treatment of suspected UTI. Immediate prescribing of the most appropriate antibiotic, for the most appropriate duration may reduce risk of adverse outcomes, particularly in high-risk patients, like those with underlying kidney disease. Therefore, this research will assess outcomes for older people prescribed immediate antibiotics for suspected UTI and compare outcomes for different antibiotics, different durations, and in patients with kidney disease.
Urinary tract infections (UTIs) are a common cause of morbidity in older people. Most older people with a suspected UTI consult their GP and may receive a prescription for empirical antibiotics. Little is known about rates of adverse outcomes following this approach, nor about associations between different empirical antibiotic prescribing strategies and outcomes, especially in higher risk groups, e.g., those with impaired renal function. There is also uncertainty around the optimal duration of treatment in this population, with limited evidence for the current practice of three-day therapy in women and seven-day therapy in men. This study will address these evidence gaps using linked CPRD GOLD, HES admitted patient care, and ONS death registry data. We will compare outcomes for different antibiotic prescribing strategies in patients aged >65 empirically treated for suspected UTI in primary care, and estimate risks of adverse outcomes according to renal function. We will explore potential predictors of early serious adverse outcomes. We will use multivariable logistic regression and propensity score-matching methods to estimate risk ratios and adjust for a range of confounding variables. Our research will inform clinical practice by providing evidence for appropriate empirical antibiotic prescribing for older people presenting to primary care with suspected UTI.
Primary care re-consultation; Hospitalisation for pyelonephritis; Death; Primary care antibiotic prescription; Hospitalisation for sepsis; UTI related hospitalisation; Hospitalisation for acute kidney injury.
Harry Ahmed - Chief Investigator - Cardiff University
Harry Ahmed - Corresponding Applicant - Cardiff University
Christopher Butler - Collaborator - Cardiff University
Daniel Farewell - Collaborator - Cardiff University
Nicholas Francis - Collaborator - Cardiff University
Shantini Paranjothy - Collaborator - University of Aberdeen
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation