Empirical Antibiotic Treatment Does Not Improve Outcomes in Catheter-Associated Urinary Tract Infection: Prospective Cohort Study

• Published in: Clinical infectious diseases 2017-12, Vol.65 (11), p.1799-1805
• Main Authors: Babich, Tanya, Zusman, Oren, Elbaz, Michal, Ben-Zvi, Haim, Paul, Mical, Leibovici, Leonard, Avni, Tomer
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; ARTICLES AND COMMENTARIES; Catheter-Related Infections - drug therapy; Catheter-Related Infections - microbiology; Catheter-Related Infections - mortality; Catheters; Clinical outcomes; Cohort analysis; Cohort Studies; Confidence intervals; Cross Infection - drug therapy; Drug therapy; Empirical analysis; Female; Geriatrics; Health care; Humans; Infections; Logistic Models; Male; Medical instruments; Mortality; Multivariate analysis; Odds Ratio; Older people; Patients; Propensity Score; Proportional Hazards Models; Prospective Studies; Regression analysis; Risk analysis; Risk Factors; Sepsis; Statistical analysis; Survival; Time Factors; Treatment Outcome; Urinary tract; Urinary tract infections; Urinary Tract Infections - drug therapy
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cix680

Catheter associated urinary tract infection (CAUTI) is the most common healthcare-associated acquired infection. We aimed to describe the short- and long-term survival of patients with CAUTI and the impact of the empirical antibiotic treatment on survival rates. In this prospective observational study we included consecutive adult patients with a chronic indwelling catheter-associated UTI and sepsis hospitalized in medical departments. The primary outcomes were 30-days all-cause mortality and long-term survival at end of the follow-up. A multivariate analysis using logistic regression and Cox proportional hazard model was performed to identify independent risk factors for an adverse outcome. A propensity-score model for receiving appropriate empirical antibiotic therapy was constructed and used to match patients. Overall, 315 consecutive patients with CAUTI were enrolled. The cohort consisted of elderly to very old patients (mean age 79.2 ± 11.5). The crude 30-day all-cause mortality rate was 30.8% (97/315). The median survival time was 82 days (interquartile range [IQR] 22-638). Appropriate early empirical treatment had no statistically significant association with 30-day mortality, propensity score-matched odds ratio (OR) 1.39 (0.76-2.55). Similarly, in the propensity-matched cohort, appropriate empirical treatment was not statistically associated with long-term survival (hazard ratio [HR] = 0.99, 95% confidence interval [CI] 0.75-1.3). In our setting, patients with CAUTI had poor short- and long-term prognosis regardless of appropriate empirical antibiotic treatment. Avoiding empirical antibiotics for CAUTI might be an important antibiotic stewardship intervention in hospitals.