Bacterial Resistance to Cephalosporin Treatment in Elderly Stable Patients Hospitalized With a Urinary Tract Infection.
Aged
Aged, 80 and over
Anti-Bacterial Agents
Cephalosporin Resistance
Cephalosporins
/ therapeutic use
Enterobacteriaceae Infections
/ drug therapy
Female
Hospitalization
Humans
Length of Stay
Male
Retrospective Studies
Treatment Outcome
Urinary Tract Infections
/ drug therapy
beta-Lactamases
/ biosynthesis
Bacterial resistance
Cephalosporins
Elderly
Hospitalized
Urinary tract infection
Journal
The American journal of the medical sciences
ISSN: 1538-2990
Titre abrégé: Am J Med Sci
Pays: United States
ID NLM: 0370506
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
22
10
2019
revised:
13
03
2020
accepted:
05
05
2020
pubmed:
3
6
2020
medline:
7
10
2020
entrez:
3
6
2020
Statut:
ppublish
Résumé
It is unclear if parenteral cephalosporin treatment is appropriate in stable elderly patients hospitalized with a urinary tract infection (UTI) in settings with a high prevalence of bacterial resistant organisms. We selected 934 consecutive stable patients aged ≥65 years with a UTI, 94.4% (n = 882) treated with a parenteral cephalosporin. Patients were divided into those with and without bacterial resistance to initial antibiotic therapy (BRIAT). Outcome measures were response to antibiotic therapy at 72 hours, prolonged hospitalization (>5 days) and mortality. There were 316 patients (33.8%) with BRIAT. At 72 hours, 33.9% (107/316) did not respond to initial treatment. The odds of a prolonged hospitalization was 2.1 (95% confidence interval-1.6-2.9), but no patient with BRIAT died from urosepsis (0%, 95% confidence interval-0-1.2%). In elderly stable patients hospitalized with a UTI, treatment with a parenteral cephalosporin might be appropriate despite a high prevalence of resistant organisms.
Sections du résumé
BACKGROUND
It is unclear if parenteral cephalosporin treatment is appropriate in stable elderly patients hospitalized with a urinary tract infection (UTI) in settings with a high prevalence of bacterial resistant organisms.
METHODS
We selected 934 consecutive stable patients aged ≥65 years with a UTI, 94.4% (n = 882) treated with a parenteral cephalosporin. Patients were divided into those with and without bacterial resistance to initial antibiotic therapy (BRIAT). Outcome measures were response to antibiotic therapy at 72 hours, prolonged hospitalization (>5 days) and mortality.
RESULTS
There were 316 patients (33.8%) with BRIAT. At 72 hours, 33.9% (107/316) did not respond to initial treatment. The odds of a prolonged hospitalization was 2.1 (95% confidence interval-1.6-2.9), but no patient with BRIAT died from urosepsis (0%, 95% confidence interval-0-1.2%).
CONCLUSIONS
In elderly stable patients hospitalized with a UTI, treatment with a parenteral cephalosporin might be appropriate despite a high prevalence of resistant organisms.
Identifiants
pubmed: 32482350
pii: S0002-9629(20)30181-6
doi: 10.1016/j.amjms.2020.05.008
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cephalosporins
0
beta-Lactamases
EC 3.5.2.6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
243-247Informations de copyright
Copyright © 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.