Survival After Suspected Urinary Tract Infection in Individuals with Advanced Dementia

Abstract

To determine whether antimicrobial treatment for suspected urinary tract infections (UTIs) improves survival in nursing home residents with advanced dementia. Prospective cohort study. Thirty-five nursing homes in Boston, Massachusetts. Nursing home residents who experienced at least one suspected UTI over a 12-month period (N = 110); mean participant age 86.4 ± 6.2, 84% female. Analyses were at the level of the UTI episode. Antimicrobial treatment for each suspected UTI was categorized as none, oral, intramuscular, or intravenous or hospitalization. Survival was calculated from the date of suspected UTI episode until death or last known follow-up date. Covariates included resident and episode characteristics. Cox proportional hazards regression was used to examine the association between treatment group and risk of death after adjusting for covariates. Residents experienced 196 suspected UTIs over the follow-up period; 33% (n = 36) died during follow-up. There was no antimicrobial use for 25.0% of the 196 suspected UTIs, oral antimicrobial use in 59.7%; intramuscular antimicrobial use in 9.2%, and intravenous antimicrobial use or hospital transfer in 6.1%. After multivariable adjustment, antimicrobial treatment was not significantly associated with mortality (oral, adjusted hazard ratio for death (AHR) = 1.09, 95% confidence interval (CI) = 0.43-2.75; intramuscular, AHR = 0.66, 95% CI = 0.08-5.66; intravenous or hospitalization, AHR = 1.83, 95% CI = 0.44-7.60). Although the majority of suspected UTIs that nursing home residents with advanced dementia experienced were treated with antimicrobials, treatment was not associated with survival.