No association between appropriate antibiotics and survival of elderly CAUTI patients

The results suggest that clinicians could defer antibiotic treatment of catheter-associated urinary tract infections (CAUTI) in some patients until full clinical and microbiologic evaluation is complete, the study authors said.

Appropriate antibiotic treatment did not extend survival among inpatients with chronic indwelling catheter-associated urinary tract infections (CAUTIs) and sepsis, according to a recent study.

The prospective observational study included 315 Israeli patients hospitalized with CAUTI and sepsis. They were elderly (mean age, 79 years) and chronically ill (62.8% were hospitalized in the three months prior, 63.5% had an indwelling urinary catheter for over 30 days, and only 11% were functionally independent). The primary outcomes were mortality at 30 days and one year. Results were published online by Clinical Infectious Diseases on Aug. 2.

Antibiotic therapy was initiated within six hours of presentation in 94% of patients, and 49% of patients were found to have received appropriate empirical antibiotic treatment. The overall 30-day all-cause mortality rate was 30.8%, and the median survival time was 82 days. Receiving appropriate antibiotic therapy was not associated with any significant difference in 30-day mortality, and patients receiving appropriate therapy actually had higher mortality (32.9% vs. 28.8%; adjusted odds ratio, 1.35; 95% CI, 0.78 to 2.32). Only 33% of patients were still alive at one year. Appropriate antibiotic therapy was not associated with any significant difference in long-term survival (propensity-matched hazard ratio, 0.99; 95% CI, 0.75 to 1.3). The study also found no association between appropriate antibiotic treatment and length of stay or length of febrile illness.

The results differ from previous research on other patient populations with severe bacterial infections, the authors noted. That may be due to the old age and frailty of these patients or the difficulty of distinguishing between symptomatic UTI and febrile illness from a non-urinary source of infection in patients with long-term catheters, they speculated. The study was limited by taking place in a single center with a high rate of resistant pathogens and among a patient population with impaired cognitive function, low functional status, and multiple comorbidities.

Still, the results suggest that clinicians could steward antibiotics by deferring antibiotic treatment of CAUTI until full clinical and microbiologic evaluation is complete, the authors suggested. “Sepsis trend and culture results will dictate directed antibiotic treatment. Our study suggests that such a strategy will not harm patients,” they wrote. Further studies should try to identify subgroups of patients that benefit from early empirical antibiotic treatment, the authors said.