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Give antibiotics for UTI to lessen sepsis risk

Antibiotics should be given when urinary tract infection is suspected in older people to lessen the risk of sepsis and the need for hospital admission

Antibiotics should be given when urinary tract infection is suspected in older people to lessen the risk of sepsis and the need for hospital admission


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Urinary tract infection (UTI) is the most common bacterial infection in older people. The spectrum of UTI ranges from a mild self-limiting infection to severe sepsis, with a mortality rate of 20-40%.

The incidence of sepsis increases with age, and UTI in older men is especially likely to be severe. Both sexes develop UTI in older age. In people over the age of 70 it is still slightly more common in women, but nothing like the overwhelming susceptibility of females in the younger population.

The diagnosis of UTI in older patients can be problematic. Symptoms are less clear-cut, with a change in behaviour being more likely than localised symptoms such as a burning feeling when passing urine.

This retrospective study examined the primary care records of 157,264 adults aged over 65 with a suspected or confirmed UTI. The rate of sepsis was significantly higher in those who were not prescribed antibiotics.

Those visiting their GP for a second time within seven days of the initial consultation and then given antibiotics were also at greater risk than those given antibiotics straight away. Overall, patients who had their antibiotic treatment delayed or received no antibiotics were up to eight times more likely to develop sepsis.

The researchers conclude that there is a greater risk of sepsis and mortality or hospital admission in older people who are not immediately given antibiotics when UTI is suspected. Early treatment with antibiotics for UTI is particularly important in high-risk populations, such as those living in deprived areas and men over 85.


Ruth Sander is an independent consultant in the care of older people

Further information

National Institute for Health and Care Excellence (2019) Urinary tract infections overview

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