Incidence and predictors of urinary tract infections after sodium-glucose cotransporter 2 inhibitor initiation in older adults hospitalized for heart failure

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.