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. 2021 Jul 23;21(1):436.
doi: 10.1186/s12877-021-02378-5.

Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study

Haley J Appaneal  1   2   3   4 , Theresa I Shireman  5 , Vrishali V Lopes  6 , Vincent Mor  7   5 , David M Dosa  6   7   8   5 , Kerry L LaPlante  6   7   8   9 , Aisling R Caffrey  6   7   8   5
Affiliations

Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study

Haley J Appaneal et al. BMC Geriatr. .

Abstract

Background: Antibiotic use is associated with several antibiotic-related harms in vulnerable, older long-term care (LTC) residents. Suboptimal antibiotic use may also be associated with harms but has not yet been investigated. The aim of this work was to compare rates of poor clinical outcomes among LTC residents with UTI receiving suboptimal versus optimal antibiotic treatment.

Methods: We conducted a retrospective cohort study among residents with an incident urinary tract infection (UTI) treated in Veterans Affairs LTC units (2013-2018). Potentially suboptimal antibiotic treatment was defined as use of a suboptimal initial antibiotic drug choice, dose frequency, and/or excessive treatment duration. The primary outcome was time to a composite measure of poor clinical outcome, defined as UTI recurrence, acute care hospitalization/emergency department visit, adverse drug event, Clostridioides difficile infection (CDI), or death within 30 days of antibiotic discontinuation. Shared frailty Cox proportional hazard regression models were used to compare the time-to-event between suboptimal and optimal treatment.

Results: Among 19,701 LTC residents with an incident UTI, 64.6% received potentially suboptimal antibiotic treatment and 35.4% experienced a poor clinical outcome. In adjusted analyses, potentially suboptimal antibiotic treatment was associated with a small increased hazard of poor clinical outcome (aHR 1.06, 95% CI 1.01-1.11) as compared with optimal treatment, driven by an increased hazard of CDI (aHR 1.94, 95% CI 1.54-2.44).

Conclusion: In this national cohort study, suboptimal antibiotic treatment was associated with a 6% increased risk of the composite measure of poor clinical outcomes, in particular, a 94% increased risk of CDI. Beyond the decision to use antibiotics, clinicians should also consider the potential harms of suboptimal treatment choices with regards to drug type, dose frequency, and duration used.

Keywords: Community living center; Suboptimal antibiotic treatment; Urinary tract infection; Veterans affairs.

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Conflict of interest statement

Haley Appaneal is supported in part by a Career Development Award, Department of Veterans Affairs and has received research funding from Shionogi.

Theresa Shireman has no conflicts.

Vrishali Lopes has no conflicts.

Vincent Mor Chairs the Scientific Advisory Committee for naviHealth, a post-acute care convener serving MA plans and hospital systems.

David Dosa has no conflicts.

Kerry LaPlante has received research funding or acted as a scientific advisor for Merck, Ocean Spray, Pfizer, Allergan, Nabriva, and Paratek.

Aisling Caffrey has received research funding from Pfizer, Merck, and Shionogi.

All authors have funded projects from the Veterans Health Administration.

Figures

Fig. 1
Fig. 1
Flow chart for study population. CLC = Community Living Center, ICD-9/ICD-10 = International Classification of Diseases, 9th or 10th Revision diagnosis codes, UTI = Urinary tract infection; VA = Veterans Affairs. Figure adapted from previously published work [27].
See this image and copyright information in PMC

Comment in

  • Geriatrics.
    Griebling TL. Griebling TL. J Urol. 2022 Apr;207(4):904-906. doi: 10.1097/JU.0000000000002403. Epub 2022 Jan 6. J Urol. 2022. PMID: 34986647 No abstract available.

References

    1. CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019. Available online: The full 2019 AR Threats Report, including methods and appendices, is available online at www.cdc.gov/DrugResistance/Biggest-Threats.html. 10.15620/cdc:82532. - DOI
    1. World Health Organization . Global priority list of antibiotic-resistant bacteria to guide research, discover, and development of new antibiotics. 2017.
    1. CDC . The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta: US Department of Health and Human Services, CDC; 2015.
    1. Reece R, Chace P, Ranucci S. Antimicrobial Stewardship in Long-Term Care Facilities. R I Med J (2013) 2018;101(5):42–44. - PubMed
    1. Beckett CL, Harbarth S, Huttner B. Special considerations of antibiotic prescription in the geriatric population. Clin Microbiol Infect. 2015;21(1):3–9. doi: 10.1016/j.cmi.2014.08.018. - DOI - PubMed

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