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

BMC Geriatrics

Theresa I. Shireman¹  Vincent Mor²  Vrishali V. Lopes³  Haley J. Appaneal⁴  David M. Dosa⁴  Aisling R. Caffrey⁴  Kerry L. LaPlante⁵ 

[1] Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA;Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA;Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA;Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, 830 Chalkstone Ave, 02908, Providence, RI, USA;Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, 830 Chalkstone Ave, 02908, Providence, RI, USA;Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA;College of Pharmacy, University of Rhode Island, Kingston, RI, USA;Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA;Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, 830 Chalkstone Ave, 02908, Providence, RI, USA;Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA;College of Pharmacy, University of Rhode Island, Kingston, RI, USA;Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA;

关键词: Urinary tract infection;    Suboptimal antibiotic treatment;    Veterans affairs;    Community living center;   

DOI  :  10.1186/s12877-021-02378-5

来源: Springer

【 摘 要 】

BackgroundAntibiotic 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.MethodsWe 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.ResultsAmong 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).ConclusionIn 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.

【 授权许可】

CC BY