Population incidence and associated mortality of urinary tract infection in people living with dementia - 17/05/24

Doi : 10.1016/j.jinf.2024.106167

Helen Lai ^a,^b, Magdalena Kolanko ^a,^b, Lucia M. Li ^a,^b, Megan E. Parkinson ^a,^c, Niall J. Bourke ^b,^d, Neil S.N. Graham ^a,^b, Michael C.B. David ^a,^b, Emma-Jane Mallas ^a,^b, Bowen Su ^e, Sarah Daniels ^a,^b, Danielle Wilson ^a,^b, Mara Golemme ^a,^b, Claire Norman ^a,^g, Kirsten Jensen ^a,^f, Raphaella Jackson ^a,^f, Martin Tran ^a,^f, Paul S. Freemont ^a,^f, David Wingfield ^a,^b,^g, Tim Wilkinson ^h, Edward W. Gregg ^e,ⁱ, Ioanna Tzoulaki ^e,^j, David J. Sharp ^a,^b,^{^{1
Senior authors: David J. Sharp, Eyal Soreq.}}, Eyal Soreq ^a,^⁎,^{^{1
Senior authors: David J. Sharp, Eyal Soreq.}}
^a UK Dementia Research Institute Care Research and Technology Centre (UK DRI CR&T) at Imperial College London and the University of Surrey, Imperial College London, White City Campus, 86 Wood Lane, London W12 0BZ, UK
^b Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
^c Perioperative and Ageing Group, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
^d Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, 16 De Crespigny Park, London SE5 8AB, UK
^e Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
^f Section of Structural and Synthetic Biology, Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK
^g Brook Green Medical Centre, Hammersmith and Fulham GP Partnership, Bute Gardens, London W6 7EG, UK
^h Centre for Clinical Brain Sciences, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK
ⁱ School of Population Health, Royal College of Surgeons of Ireland, University of Medicine and Health Sciences, 123 St Stephen’s Green, Dublin 2, Ireland
^j Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, Athens 115 27, Greece

^⁎Correspondence to: Imperial College London, White City Campus, 9/F, Sir Michael Uren Hub, W12 0BZ London, UK.Imperial College LondonWhite City Campus, 9/F, Sir Michael Uren HubLondonW12 0BZUK

Summary

Objectives

Urinary tract infections (UTIs) frequently cause hospitalisation and death in people living with dementia (PLWD). We examine UTI incidence and associated mortality among PLWD relative to matched controls and people with diabetes and investigate whether delayed or withheld treatment further impacts mortality.

Methods

Data were extracted for n = 2,449,814 people aged ≥ 50 in Wales from 2000–2021, with groups matched by age, sex, and multimorbidity. Poisson regression was used to estimate incidences of UTI and mortality. Cox regression was used to study the effects of treatment timing.

Results

UTIs in dementia (HR=2.18, 95 %CI [1.88–2.53], p < .0) and diabetes (1.21[1.01–1.45], p = .035) were associated with high mortality, with the highest risk in individuals with diabetes and dementia (both) (2.83[2.40–3.34], p < .0) compared to matched individuals with neither dementia nor diabetes. 5.4 % of untreated PLWD died within 60 days of GP diagnosis—increasing to 5.9 % in PLWD with diabetes.

Conclusions

Incidences of UTI and associated mortality are high in PLWD, especially in those with diabetes and dementia. Delayed treatment for UTI is further associated with high mortality.

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Graphical Abstract

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Keywords : Urinary tract infections, Diabetes mellitus, Dementia, Anti-bacterial agents, Therapeutics, Population health, Incidence, Mortality, Comorbidity

Plan

Introduction

Materials and methods

Study design and study population

Data processing and statistical analysis

Results

Cohort description

Incidence of UTI in dementia and diabetes

High mortality rates in dementia following UTI

Temporal sensitivity analysis

Diagnosis sensitivity analysis

Time since diagnosis sensitivity analysis

High rates of mortality with delayed treatment for diabetes and dementia

Discussion

Ethical approval

Funding

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Vol 88 - N° 6

Article 106167- juin 2024 Retour au numéro

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Population incidence and associated mortality of urinary tract infection in people living with dementia - 17/05/24

Summary

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Results

Conclusions

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Plan

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