The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults.

BACKGROUND The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults. METHODS We conducted a matched cohort study comparing older adults (≥66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for at least 30 days starting within 30 days of a positive culture, to patients with positive urine cultures that received antibiotic treatment but did not receive prophylaxis. We matched each prophylaxis recipient to 10 non-recipients based on organism, number of positive cultures, and propensity score. Outcomes included 1) emergency department (ED) visit or hospitalization for UTI, sepsis, or bloodstream infection within 1 year; 2) acquisition of antibiotic resistance in urinary tract pathogens; 3) antibiotic-related complications. RESULTS Overall 4.7% (151/3,190) of UTI prophylaxis patients and 3.6% (n=1,092/30,542) controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection (Hazard Ratio (HR) 1.33, 95%CI 1.12 to 1.57). Acquisition of antibiotic resistance to any urinary antibiotic (HR 1.31, 95%CI 1.18 to 1.44) and to the specific prophylaxis agent (HR 2.01, 95% CI 1.80 to 2.24) were higher in patients receiving prophylaxis. While the overall risk of antibiotic-related complications was similar between groups (HR 1.08, 95%CI 0.94 to 1.22) the risk of C. difficile and general medication adverse events was higher in prophylaxis recipients (HR 1.56, 95%CI 1.05 to 2.23; HR 1.62, 95%CI 1.11 to 2.29, respectively). CONCLUSIONS Among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits.