Incidence and predictors of urinary tract infections after sodium-glucose cotransporter 2 inhibitor initiation in older adults hospitalized for heart failure - 22/10/26
, Arthur Leroy-Mobeche a, 1, Gilles Berrut a, Lionel Moulis d, Manuela Dalberto a, Mélissa Gentreau b, e, Georges Marroun c, Florence Leclercq f, Hubert Blain aGraphical abstract |
Highlights |
• | Suspected UTI occurred in 17.3% within 6 months of SGLT2 inhibitor initiation. |
• | An extreme worst-case analysis yielded an upper bound of 35.0%. |
• | History of UTI was the only predictor robust across missing-outcome scenarios. |
• | Findings support risk-based counselling, patient education and close monitoring. |
Abstract |
Background |
Sodium-glucose cotransporter 2 inhibitors are recommended for heart failure treatment across the spectrum of ejection fraction; however, by promoting glycosuria, they may increase the risk of urinary tract infection, particularly in older adults.
Aims |
To assess the 6-month incidence of urinary tract infection following sodium-glucose cotransporter 2 inhibitor initiation in older patients hospitalized for heart failure, and to identify associated factors.
Methods |
This retrospective single-centre study included patients aged ≥ 75 years hospitalized for heart failure in geriatric and cardiology wards, and initiated on a sodium-glucose cotransporter 2 inhibitor between January 2022 and December 2024. The primary outcome was physician-diagnosed antibiotic-treated suspected urinary tract infection within 6 months, investigated using multivariable logistic regression.
Results |
Of 260 included patients, 147 were hospitalized in the cardiology ward and 113 in the geriatric ward. Physician-diagnosed antibiotic-treated suspected urinary tract infection was recorded in 45 patients, corresponding to 17.3% of the total cohort and 21.0% of patients with an ascertainable outcome; the upper bound under the extreme worst-case assumption was 35.0%. Incidence was higher in the geriatric ward than in the cardiology ward (26.6 vs. 10.2%). After age matching, female sex (odds ratio 3.15, 95% confidence interval 1.22–8.14), history of urinary tract infection (odds ratio 3.05, 95% confidence interval 1.25–7.42), diabetes mellitus (odds ratio 3.17, 95% confidence interval 1.32–7.60) and geriatric ward hospitalization (odds ratio 3.84, 95% confidence interval 1.62–9.07) were associated with increased odds of urinary tract infection, although only history of urinary tract infection remained robust across missing-outcome sensitivity analyses.
Conclusions |
Suspected urinary tract infection was frequent after sodium-glucose cotransporter 2 inhibitor initiation in hospitalized older adults. History of urinary tract infection was the most robust predictor, supporting individualized risk assessment and monitoring rather than routine prophylaxis.
Le texte complet de cet article est disponible en PDF.Keywords : Heart failure, Sodium-glucose cotransporter 2 inhibitor, Urinary tract infection, Geriatric medicine, Drug-related side effects and adverse reactions
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