title: Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study.
abstract: To determine the consequences of treating febrile geriatric patients with a suspected urinary tract infection (UTI) with antibiotics that have high resistance rates due primarily to extended-spectrum β-lactamase (ESBL) producing bacteria.
  
  
  
  In this cohort study, we selected 257 consecutive hospitalised patients aged ≥70 years with a chief symptom of fever, possibly due to a UTI and initially treated with antibiotics with rates in our hospital of urinary culture resistance >20%. Patients with severe sepsis were excluded. The main outcomes measures were in vitro bacterial resistance to initial antibiotic therapy (BRIAT), response to therapy, hospitalisation days and mortality.
  
  
  
  Urine cultures were positive in 64.2% (165 of 257) of the patients and BRIAT occurred in 28.0% (72 of 257). Response rates were 100% (93 of 93) in those with bacteria sensitive to initial antibiotic therapy, 95.7% (88 of 92) in the culture negative patients, and 66.7% (48 of 72) in those with BRIAT (p<0.001). There were no deaths due to deterioration during the initial treatment period because of BRIAT. In the patients with BRIAT, the median length of hospitalisation was 3 days longer than that in the other patients (7 and 4 days, respectively, p<0.001).
  
  
  
  We conclude that initial broad spectrum antibiotic treatment could potentially lower the median length of hospitalisation by 3 days in many hospitalised geriatric patients without an extra-urinary tract source for their fever. This benefit needs to be balanced against the risk to the individual patient and to the general public of increasing bacterial resistance rates to broader spectrum antibiotics often held in reserve.
authors.affiliation: Department of Internal Medicine B, Laniado Hospital, Netanya, Israel.|Ruth and Bruce Rappaport School of Medicine, Haifa, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Shimoni
authors.affiliation: Infectious Disease Department, Laniado Hospital, Netanya, Israel.
authors.forename: Regev
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Department of Internal Medicine B, Laniado Hospital, Netanya, Israel.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Avdiaev
authors.affiliation: Department of Clinical Utility, Laniado Hospital, Netanya, Israel.|School of Public Health, University of Tel Aviv, Tel Aviv, Israel.
authors.forename: Paul
authors.initials: P
authors.lastname: Froom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D024881:Drug Resistance, Bacterial; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D017053:Infection Control; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000188:drug therapy*; D014556:Urine / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: GERIATRIC MEDICINE; INFECTIOUS DISEASES