{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T16:59:12Z","timestamp":1778173152994,"version":"3.51.4"},"reference-count":20,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,11,8]]},"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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 \u03b2-lactamase (ESBL) producing bacteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cohort study, we selected 257 consecutive hospitalised patients aged \u226570\u2005years 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 &gt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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&lt;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\u2005days longer than that in the other patients (7 and 4\u2005days, respectively, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We conclude that initial broad spectrum antibiotic treatment could potentially lower the median length of hospitalisation by 3\u2005days 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-013696","type":"journal-article","created":{"date-parts":[[2016,12,24]],"date-time":"2016-12-24T13:35:38Z","timestamp":1482586538000},"page":"e013696","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Treatment of febrile geriatric patients with suspected urinary tract infections in a hospital with high rates of ESBL producing bacteria: a cohort study"],"prefix":"10.1136","volume":"6","author":[{"given":"Zvi","family":"Shimoni","sequence":"first","affiliation":[{"name":"Department of Internal Medicine B, Laniado Hospital, Netanya, Israel"},{"name":"Ruth and Bruce Rappaport School of Medicine, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regev","family":"Cohen","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, Laniado Hospital, Netanya, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruslan","family":"Avdiaev","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B, Laniado Hospital, Netanya, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Froom","sequence":"additional","affiliation":[{"name":"Department of Clinical Utility, Laniado Hospital, Netanya, Israel"},{"name":"School of Public Health, University of Tel Aviv, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,12,16]]},"reference":[{"key":"2025121410081872000_6.12.e013696.1","doi-asserted-by":"publisher","DOI":"10.1086\/313896"},{"key":"2025121410081872000_6.12.e013696.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2013.10.008"},{"key":"2025121410081872000_6.12.e013696.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmii.2010.06.001"},{"key":"2025121410081872000_6.12.e013696.4","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01823-12"},{"key":"2025121410081872000_6.12.e013696.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)70950-8"},{"key":"2025121410081872000_6.12.e013696.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2012.03821.x"},{"key":"2025121410081872000_6.12.e013696.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1208623"},{"key":"2025121410081872000_6.12.e013696.8","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.ejim.2014.04.009","article-title":"Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections","volume":"25","author":"Esparcia","year":"2014","journal-title":"Eur J Intern Med"},{"key":"2025121410081872000_6.12.e013696.9","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000217961.75225.E9"},{"key":"2025121410081872000_6.12.e013696.10","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1016\/j.ajic.2015.05.033","article-title":"Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: a decision-tree analysis of mortality, costs, and resistance","volume":"43","author":"Parienti","year":"2015","journal-title":"Am J Infect Control"},{"key":"2025121410081872000_6.12.e013696.11","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-12-245"},{"key":"2025121410081872000_6.12.e013696.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2014.08.018"},{"key":"2025121410081872000_6.12.e013696.13","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1111\/1469-0691.12711","article-title":"Effects of gentamicin monotherapy for the initial treatment of community-onset complicated non-obstructive acute pyelonephritis due to Enterobacteriaceae in elderly and non-elderly women","volume":"20","author":"Wie","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"2025121410081872000_6.12.e013696.14","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e3283398dc1"},{"key":"2025121410081872000_6.12.e013696.15","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/29.4.297"},{"key":"2025121410081872000_6.12.e013696.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.02073.x"},{"key":"2025121410081872000_6.12.e013696.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2004.07.010"},{"key":"2025121410081872000_6.12.e013696.18","first-page":"4","article-title":"Overview of ESBL-producing Enterobacteriaceae from a Nordic perspective","volume":"1","author":"Brolund","year":"2014","journal-title":"Infect Ecol Epidemiol"},{"key":"2025121410081872000_6.12.e013696.19","doi-asserted-by":"crossref","unstructured":"Doi Y , Park YS , Rivera JI , et al . 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