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Table 4 Time to event analyses among CLC residents who initially received only one antibiotic class

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

Outcome

Initial Antibiotic Treatment

Potentially suboptimal treatment [n events/n total, (%)]

Potentially optimal treatment [n events/n total, (%)]

Unadjusted HR (95% CI)

Adjusted HR (95% CI)

Poor clinical outcomea

Fluroquinolone

1581/4460 (35.4%)

588/1672 (35.2%)

1.03 (0.94–1.14)

1.05 (0.95–1.16)

Cephalosporin

722/1882 (38.4%)

661/1854 (35.7%)

1.07 (0.96–1.20)

1.06 (0.95–1.18)

Genitourinary tract agent

809/2384 (33.9%)

415/1280 (32.4%)

1.06 (0.94–1.20)

1.09 (0.96–1.23)

Other beta lactam

599/1578 (38.0%)

432/1087 (39.7%)

0.97 (0.85–1.09)

1.00 (0.88–1.13)

Hospitalization/ Emergency department visitb

Fluroquinolone

771/4460(17.3%)

312/1672 (18.7%)

0.95 (0.83–1.09)

1.01 (0.88–1.16)

Cephalosporin

406/1882(21.6%)

346/1854(18.7%)

1.08 (0.93–1.26)

1.09 (0.94–1.27)

Genitourinary tract agent

386/2384(16.2%)

217/1280(17.0%)

0.97 (0.82–1.14)

0.96 (0.81–1.15)

Other beta lactam

346/1578(21.9%)

243/1087(22.4%)

1.01 (0.86–1.20)

1.11 (0.94–1.32)

UTI recurrencec

Fluroquinolone

522/4460(11.7%)

201/1672(12.0%)

0.97 (0.82–1.14)

1.00 (0.84–1.19)

Cephalosporin

252/1882(13.4%)

251/1854(13.5%)

0.95 (0.80–1.14)

0.95 (0.79–1.14)

Genitourinary tract agent

372/2384(15.6%)

169/1280(13.2%)

1.04 (0.86–1.25)

1.06 (0.87–1.30)

Other beta lactam

180/1578(11.4%)

177/1087(16.3%)

0.69 (0.56–0.85)

0.78 (0.63–0.97)

All-cause mortalityd

Fluroquinolone

527/4460(11.8%)

173/1672(10.3%)

1.16 (0.98–1.38)

1.07 (0.89–1.28)

Cephalosporin

197/1882(10.5%)

182/1854(9.8%)

1.09 (0.88–1.33)

1.06 (0.86–1.30)

Genitourinary tract agent

228/2384(9.6%)

93/1280(7.3%)

1.29 (1.01–1.64)

1.26 (0.98–1.63)

Other beta lactam

187/1578(11.9%)

108/1087(9.9%)

1.19 (0.94–1.51)

1.15 (0.89–1.48)

Clostridioides difficile infectione

Fluroquinolone

66/4460(1.5%)

16/1672(1.0%)

1.56 (0.90–2.71)

1.91 (1.09–3.36)

Cephalosporin

41/1882(2.2%)

20/1854(1.1%)

1.99 (1.16–3.43)

1.93 (1.12–3.31)

Genitourinary tract agent

25/2384(1.0%)

12/1280(0.9%)

1.14 (0.57–2.28)

1.14 (0.55–2.35)

Other beta lactam

24/1578(1.5%)

15/1087(1.4%)

1.10 (0.58–2.10)

1.35 (0.69–2.65)

Antibiotic related adverse drug eventf

Fluroquinolone

< 0.5%

< 0.5%

0.87 (0.23–3.38)

1.02 (0.26–3.97)

Cephalosporin

< 0.5%

< 0.5%

1.14 (0.28–4.68)

1.19 (0.29–4.95)

Genitourinary tract agent

< 0.5%

< 0.5%

1.10 (0.20–6.03)

1.13 (0.21–6.18)

Other beta lactam

< 0.5%

< 0.5%

1.15 (0.27–4.81)

1.14 (0.27–4.75)

  1. CI Confidence interval, CLC Community Living Center, HR Hazard ratio, UTI Urinary tract infection, VAMC Veterans Affairs Medical Center
  2. aAdjusted for 8 resident-level covariates (genitourinary disease comorbidity, cardiopulmonary comorbidity, chronic renal disease comorbidity, previous fluroquinolone exposure in the past 30 days, age, previous VAMC hospitalization in the past 30 days, previous VAMC urine culture in the past 365 days, high white blood cell count), and 1 CLC-level covariate (total CLC incident UTI rate per 10,000 bed days)
  3. bAdjusted for 10 resident-level covariates (cardiopulmonary comorbidity, genitourinary disease comorbidity, chronic renal disease comorbidity, age, previous VAMC hospitalization in the past 30 days, previous outpatient VA urine culture in the past 365 days, previous CLC urine culture in the past 365 days, previous VAMC urine culture in the past 365 days, high white blood cell count, year of episode) and 1 CLC-level covariate (total CLC incident UTI rate per 10,000 bed days)
  4. cAdjusted for 5 resident-level covariates (genitourinary disease comorbidity, previous fluroquinolone exposure in the past 30 days, previous fluroquinolone resistant culture in the past 365 days, previous CLC urine culture in the past 365 days, previous VAMC urine culture in the past 365 days), and 1 CLC-level covariate (total CLC incident UTI rate per 10,000 bed days)
  5. dAdjusted for 10 resident-level covariates (history of a skin infection diagnosis in the past 365 days, history of a urinary tract infection diagnosis in the past 365 days, chronic renal disease comorbidity, age, previous fluroquinolone exposure in the past 30 days, previous VAMC hospitalization in the past 30 days, previous outpatient VA urine culture in the past 365 days, previous VAMC urine culture in the past 365 days, high white blood cell count, year of episode), and 1 CLC-level covariate (total CLC incident UTI rate per 10,000 bed days)
  6. eAdjusted for 8 resident-level covariates (history of a skin infection diagnosis in the past 365 days, genitourinary disease comorbidity, chronic renal disease comorbidity, previous VAMC hospitalization in the past 30 days, previous CLC urine culture in the past 365 days, previous VAMC urine culture in the past 365 days, high white blood cell count, year of episode), and 1 CLC-level covariate (total CLC incident UTI rate per 10,000 bed days)
  7. fAdjusted for 2 resident-level covariates (VAMC hospitalization in the past 30 days, year of episode), and 1 CLC-level covariate (total CLC incident UTI rate per 10,000 bed days)
  8. All covariates were included in adjusted models as dichotomous variables representing presence as compared to absence of the characteristic of interest, unless otherwise noted. Age was included as a categorical variable (≥ 85, 75–84, 65–74 years) as compared to < 65 years. Recent high WBC was included as a WBC > 10 × 103/μL within 7 days prior to treatment as compared to a measurement below or missing. Total CLC incident UTI rate per 10,000 bed days was included as a continuous variable. Year of episode was included as a discrete variable for each year
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BMC Geriatrics

ISSN: 1471-2318

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