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Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study
  1. Zvi Shimoni1,2,
  2. Regev Cohen3,
  3. Ruslan Avdiaev1,
  4. Paul Froom4,5
  1. 1Department of Internal Medicine B, Laniado Hospital, Netanya, Israel
  2. 2Ruth and Bruce Rappaport School of Medicine, Haifa, Israel
  3. 3Infectious Disease Department, Laniado Hospital, Netanya, Israel
  4. 4Department of Clinical Utility, Laniado Hospital, Netanya, Israel
  5. 5School of Public Health, University of Tel Aviv, Tel Aviv, Israel
  1. Correspondence to Professor Paul Froom; froomp{at}gmail.com

Abstract

Purpose To determine the consequences of treating febrile geriatric patients with a suspected urinary tract infection (UTI) with antibiotics that have high resistance rates due primarily to extended-spectrum β-lactamase (ESBL) producing bacteria.

Methods In this cohort study, we selected 257 consecutive hospitalised patients aged ≥70 years with a chief symptom of fever, possibly due to a UTI and initially treated with antibiotics with rates in our hospital of urinary culture resistance >20%. Patients with severe sepsis were excluded. The main outcomes measures were in vitro bacterial resistance to initial antibiotic therapy (BRIAT), response to therapy, hospitalisation days and mortality.

Results Urine cultures were positive in 64.2% (165 of 257) of the patients and BRIAT occurred in 28.0% (72 of 257). Response rates were 100% (93 of 93) in those with bacteria sensitive to initial antibiotic therapy, 95.7% (88 of 92) in the culture negative patients, and 66.7% (48 of 72) in those with BRIAT (p<0.001). There were no deaths due to deterioration during the initial treatment period because of BRIAT. In the patients with BRIAT, the median length of hospitalisation was 3 days longer than that in the other patients (7 and 4 days, respectively, p<0.001).

Conclusions We conclude that initial broad spectrum antibiotic treatment could potentially lower the median length of hospitalisation by 3 days in many hospitalised geriatric patients without an extra-urinary tract source for their fever. This benefit needs to be balanced against the risk to the individual patient and to the general public of increasing bacterial resistance rates to broader spectrum antibiotics often held in reserve.

  • GERIATRIC MEDICINE
  • INFECTIOUS DISEASES

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors All authors contributed significantly to this manuscript, including contributions in the study design (ZS, RC, RA, PF), chart reviews (ZS, RA, PF), interpretation of the data (ZS, RC, RA, PF), and preparation of the manuscript (ZS, RC, RA and PF).

  • Competing interests None declared.

  • Ethics approval We received approval from the hospital ethics committee—21.1.2014–0003–14LND. The Israeli Ministry of Health reviews the decisions of the hospital's ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement no additional data are available.

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