Antibiotic Selection and Duration for Catheter-Associated Urinary Tract Infection in Non-Hospitalized Older Adults: A Population-Based Cohort Study

Bradley J Langford; Nick Daneman; Christina Diong; Samantha M Lee; Daniel J Fridman; Jennie Johnstone; Derek MacFadden; Kwadwo Mponponsuo; Samir N Patel; Kevin L Schwartz; Kevin A Brown

doi:10.1017/ash.2023.176

Antibiotic Selection and Duration for Catheter-Associated Urinary Tract Infection in Non-Hospitalized Older Adults: A Population-Based Cohort Study

Antimicrob Steward Healthc Epidemiol. 2023 Aug 1;3(1):e132. doi: 10.1017/ash.2023.176. eCollection 2023.

Authors

Bradley J Langford^#^{1

2}, Nick Daneman^{1

3

4

5}, Christina Diong⁴, Samantha M Lee⁴, Daniel J Fridman⁴, Jennie Johnstone^{1

2

6

7}, Derek MacFadden⁸, Kwadwo Mponponsuo^{4

9}, Samir N Patel^{1

7}, Kevin L Schwartz^{1

2

4

10}, Kevin A Brown^{1

2

4}

Affiliations

¹ Public Health Ontario, Toronto, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
³ Sunnybrook Health Sciences Centre, Toronto, Canada.
⁴ ICES, Toronto, Canada.
⁵ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
⁶ Sinai Health, Toronto, Canada.
⁷ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
⁸ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁹ Department of Medicine Section of Infectious Diseases, University of Calgary, Calgary, Canada.
¹⁰ St. Joseph's Health Centre, Unity Health, Toronto, Canada.

^# Contributed equally.

Abstract

Background: We sought to evaluate the impact of antibiotic selection and duration of therapy on treatment failure in older adults with catheter-associated urinary tract infection (CA-UTI).

Methods: We conducted a population-based cohort study comparing antibiotic treatment options and duration of therapy for non-hospitalized adults aged 66 and older with presumed CA-UTI (defined as an antibiotic prescription and an organism identified in urine culture in a patient with urinary catheterization documented within the prior 90 d). The primary outcome was treatment failure, a composite of repeat urinary antibiotic prescribing, positive blood culture with the same organism, all-cause hospitalization or mortality, within 60 days. We determined the risk of treatment failure accounting for age, sex, comorbidities, and healthcare exposure using log-binomial regression.

Results: Of 4,436 CA-UTI patients, 2,709 (61.1%) experienced treatment failure. Compared to a reference of TMP-SMX (61.9% failure), of those treated with fluoroquinolones, 56.3% experienced failure (RR 0.91, 95% CI: 0.85-0.98) and 60.9% of patients treated with nitrofurantoin experienced failure (RR 1.02, 95% CI: 0.94-1.10). Compared to 5-7 days of therapy (treatment failure: 59.4%), 1-4 days was associated with 69.5% failure (RR 1.15, 95% CI: 1.05-1.27), and 8-14 days was associated with a 62.0% failure (RR 1.05, 95% CI: 0.99-1.11).

Conclusions: Although most treatment options for CA-UTI have a similar risk of treatment failure, fluoroquinolones, and treatment durations ≥ 5 days in duration appear to be associated with modestly improved clinical outcomes. From a duration of therapy perspective, this study provides reassurance that relatively short courses of 5-7 days may be reasonable for CA-UTI.