Association of urinary tract infections with antipsychotic drug use in older patients

Application Number
16_272
Lay Summary

Antipsychotic drugs are frequently prescribed to older patients. A recent study in the United Kingdom did report a high frequency of antipsychotic drug use of 1% in the primary care setting. Use of antipsychotics may cause serious adverse effects, including increased risks of stroke and thrombo-embolism, but it is also associated with infections like pneumonia. A recent Dutch study using pharmacy records has shown an increased risk of uncomplicated urinary tract infections in women in current users of antipsychotics. As urinary tract infections are a major cause of illness and mortality in the elderly and antipsychotic drugs are prescribed frequently in this age group, assessment of this relation is highly relevant from a clinical perspective. It is unknown whether this observed risk can be extrapolated to complicated urinary tract infections and to male antipsychotic users. Therefore, the objective of the current study is to investigate the association between use of antipsychotics in older men and women and the risk of uncomplicated and complicated urinary tract infections.

Technical Summary

The objective of the current study is to investigate the association between use of antipsychotics in older men and women and the risk of uncomplicated and complicated urinary tract infections. This study is designed as a cohort study in the United Kingdom (UK) of patients in the primary care aged over 65 years. Data will be obtained from the Clinical Practice Research Datalink (CPRD). Events are defined as diagnosis of a urinary tract infection (UTI). As UTIs can occur multiple times a year within patients, we will assess the occurrence of recurrent UTIs during the whole follow-up period. Exposure is defined as the use of antipsychotic drugs. We compare current use of antipsychotics with past use of antipsychotics. Prescriptions will be retrieved from CPRD. Information on GP-prescribed medications will be extracted using appropriate British National Formulary (BNF) medicine codes. Cox proportional hazard regression analysis Andersen-Gill extension for recurrent events will be used to calculate crude and adjusted hazard ratios (HRs) for the association between current use of antipsychotics and risk of UTI. Data analysis will be conducted with STATA SE 14.

Health Outcomes to be Measured

Urinary Tract Infection

Collaborators

Patrick Souverein - Chief Investigator - Utrecht University
Patrick Souverein - Corresponding Applicant - Utrecht University
Astrid van Strien - Collaborator - Jeroen Bosch Hospital
Carolina Keijsers - Collaborator - Jeroen Bosch Hospital
Eibert ( Rob ) Heerdink - Collaborator - University Medical Centre Utrecht
Hieronymus Derijks - Collaborator - Jeroen Bosch Hospital
Rob Van Marum - Collaborator - Jeroen Bosch Hospital