@article{Gharbi:2019:10.1136/bmj.l525,
author = {Gharbi, M and Lishman, H and Goudie, R and Molokhia, M and Johnson, A and Holmes, A and Aylin, P},
doi = {10.1136/bmj.l525},
journal = {BMJ},
title = {Antibiotic management of urinary tract infection in the elderly in primary care and its association with bloodstream infections and all-cause mortality: a population-based cohort study},
url = {http://dx.doi.org/10.1136/bmj.l525},
volume = {365},
year = {2019}
}

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TY  - JOUR
AB  - OBJECTIVETo evaluate the association between severe adverse outcomes and the antibiotic treatment for urinary tract infection (UTI) diagnosed in elderly adults in primary care. DESIGNA retrospective population-based cohort study.SETTINGClinical Practice Research Datalink (2007-2015) primary care records linked to Hospital Episode Statistics and death records in England.PARTICIPANTSPatients aged≥65 years presenting to a General Practitioner (GP) with at least one diagnosis of suspected or confirmed lower UTI from November 2007 to May 2015.MAIN OUTCOME MEASURESBloodstream infection (BSI), hospital admission and all-cause mortality within 60 days following the index UTI diagnosis.RESULTSAmong 312,896 UTI episodes (157,264 unique patients), 7% did not have a record of having been prescribed antibiotics and 6% showed a delay in antibiotic prescribing. 1,539 episodes of BSI were recorded within 60 days following the initial UTI. The rate of BSI was significantly higher among those patients who were not prescribed an antibiotic (2. 9%) and those patients recorded as returning to the GP within 7 days of the initial consultation for an antibiotic prescription (2.2%), compared with those given a prescription for an antibiotic at the initial consultation (0.2%) (p=0.001). After adjustment for covariates, patients were significantly more likely to experience a BSI in the ‘deferred antibiotics’ and ‘no antibiotics’ groups compared with the ‘immediate antibiotics’ group (aOR=7.12 [95% CI 6.22 to 8.14] and aOR=8.08 [95% CI 7.12 to 9.16]).The Number Needed to Harm (NNH) for occurrence of BSI was lower (greater risk) for the ‘no antibiotics’ group (NNH=37) than for the ‘deferred antibiotics’ group (NNH=51), relative to the ‘immediate antibiotics’ group. The rate of hospital admissions was approximately double among cases with ‘no antibiotics’ (27%) and ‘deferred antibiotics’ (27%) comp
AU  - Gharbi,M
AU  - Lishman,H
AU  - Goudie,R
AU  - Molokhia,M
AU  - Johnson,A
AU  - Holmes,A
AU  - Aylin,P
DO  - 10.1136/bmj.l525
PY  - 2019///
SN  - 0959-8138
TI  - Antibiotic management of urinary tract infection in the elderly in primary care and its association with bloodstream infections and all-cause mortality: a population-based cohort study
T2  - BMJ
UR  - http://dx.doi.org/10.1136/bmj.l525
UR  - https://www.bmj.com/content/364/bmj.l525
UR  - http://hdl.handle.net/10044/1/66891
VL  - 365
ER  - 

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