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Table 2 Baseline characteristics, initial antibiotics and outcomes among residents with urinary tract infections receiving potentially suboptimal and optimal antibiotic treatment

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

 

Potentially suboptimal antibiotic treatment (n = 12,718)

Potentially optimal antibiotic treatment (n = 6983)

P value

Baseline Characteristics

 Age in years, median (IQR)

75 (67–85)

74 (67–84)

p < 0.001

 Male gender

12,208 (96)

6698 (95.9)

0.808

 White race

9477 (74.5)

5266 (75.4)

0.166

 Chronic renal disease comorbidity

3783 (29.7)

1905 (27.3)

< 0.001

 Cardiopulmonary disease comorbidity

9156 (72)

5158 (73.9)

0.005

 Genitourinary disease comorbidity

6733 (52.9)

3833 (54.9)

0.009

 Urinary tract infection diagnosis in the year prior

4357 (34.3)

2815 (40.3)

< 0.001

 Skin or soft tissue infection diagnosis in the year prior

2631 (20.7)

1266 (18.1)

< 0.001

 Hospitalization, 30 days prior treatment

3708 (29.2)

2127 (30.5)

0.06

 Exposure to any antibiotic, 30 days prior to treatment

5650 (44.4)

2932 (42.0)

0.001

 Exposure to fluoroquinolone, 30 days prior to treatment

1840 (14.5)

776 (11.1)

< 0.001

Initial Antibiotic Treatment

 Fluoroquinolone

5403 (42.5)

1874 (26.8)

< 0.001

  Ciprofloxacin

3972 (31.2)

1585 (22.7)

< 0.001

  Levofloxacin

1458 (11.5)

292 (4.2)

< 0.001

 Cephalosporin

3160 (24.8)

2274 (32.6)

< 0.001

  Cephalexin

1076 (8.5)

287 (4.1)

< 0.001

  Ceftriaxone

656 (5.2)

972 (13.9)

< 0.001

 Typical genitourinary tract agent

2848 (22.4)

1356 (19.4)

< 0.001

  Sulfamethoxazole/trimethoprim

2330 (18.3)

1070 (15.3)

< 0.001

  Nitrofurantoin

510 (4)

273 (3.9)

0.366

 Other beta lactam

2394 (18.8)

1575 (22.6)

< 0.001

  Amoxicillin/clavulanate

1101 (8.7)

425 (6.1)

< 0.001

  Piperacillin/tazobactam

687 (5.4)

579 (8.3)

< 0.001

  Amoxicillin

487 (3.8)

328 (4.7)

0.003

 Other antibiotics

1134 (8.9)

821 (11.8)

< 0.001

  Vancomycin

975 (7.7)

711 (10.2)

< 0.001

  Clindamycin

33 (0.3)

< 5

0.001

 Treatment duration in days, median (interquartile range)

9 (7–12)

8 (6–10)

p < 0.001

Outcomesa

 Poor clinical outcome

4780 (37.6)

2557 (36.6)

0.179

  Hospitalization/ Emergency department visit

2499 (19.6)

1386 (19.8)

0.737

  UTI recurrence

1589 (12.5)

927 (13.3)

0.116

  All-cause mortality

1418 (11.1)

703 (10.1)

0.019

  Clostridioides difficile infection

339 (2.7)

98 (1.4)

< 0.001

  Antibiotic related adverse drug event

27 (0.2)

17 (0.2)

0.658

  1. CLC Community Living Center, UTI Urinary tract infection
  2. Data are presented as n (%), unless otherwise specified
  3. aCrude outcome rates at 30 days
  4. We compared baseline characteristics, initial antibiotic treatment (day 1, empiric treatment) and outcomes among CLC residents with an incident UTI receiving potentially suboptimal antibiotic treatment and those receiving potentially optimal antibiotic treatment. We present a few significant differences in baseline characteristics in the Table above. Our previous work compares baseline characteristics (including socio-demographics, comorbidities, prior healthcare exposures, prior infections, prior antibiotic exposures, prior culture collection, and prior laboratory results) between groups in more detail [27].
  5. Potentially suboptimal antibiotic treatment was defined as exposure to any subtype of potentially suboptimal antibiotic treatment: drug choice (based on previous urine cultures and susceptibilities or local CLC urine antibiogram), dose frequency (based on renal function), and/or longer than recommended duration (greater than 14 days)
  6. The following agents were included in each class: fluoroquinolones (ciprofloxacin, levofloxacin), typical genitourinary tract agents (nitrofurantoin, sulfamethoxazole/ trimethoprim, fosfomycin, trimethoprim), cephalosporins (cefaclor, cefazolin, cefotetan, cefoxitin, cefuroxime, cephalexin, cefdinir, cefepime, cefixime, cefotaxime, cefpodoxime, ceftazidime, ceftriaxone), and other beta-lactams (amoxicillin, ampicillin, amoxicillin/clavulanate, amipicillin/sulbactam, imipenem, meropenem, ertapenem, doripenem, piperacillin/ tazobactam)
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BMC Geriatrics

ISSN: 1471-2318

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