Potential Inappropriate Treatment of Suspected Urinary Tract Infections Among Nursing Home Residents

Overview

Journal Clin Sch Rev

Specialty Nursing

Date 2020 Mar 29

PMID 32218886

Authors

Angela Norman

Todd Monroe

Michael Carter

Affiliations

Soon will be listed here.

Abstract

Objective: To determine if nurse practitioners and physicians followed recommended practice guidelines prior to the initiation of antibiotics among long-term care (LTC) residents with suspected urinary tract infections (UTIs).

Methods: A retrospective review of 1-year reported cases of UTIs in 2 rural southern nursing homes.

Results: There were 175 cases of UTI reported in the 2 homes, but 6 cases were reported in error. Only 4 of the 169 remaining cases met the diagnostic criteria for UTI. The remaining 169 cases received inappropriate antibiotics. Some of these cases may represent asymptomatic bacteria rather than UTI. Problems were identified with the methods used to collect urine sample that were sent to the laboratory for culture.

Conclusion: We found that in 2 nursing homes, almost all of the reported cases of UTI did not meet the accepted diagnostic criteria. Also, there was inappropriate antibiotic therapy for most of these residents. Nurse practitioners and physicians should accurately determine the presence of UTI and document in the medical record prior to initiating antibiotic. Urine specimens should be collected using appropriate methods. Nursing homes should only report to the Centers for Medicare and Medicaid Services (CMS) those cases that meet the diagnostic criteria as a UTI.

References

Beveridge L, Davey P, Phillips G, McMurdo M . Optimal management of urinary tract infections in older people. Clin Interv Aging. 2011; 6:173-80. PMC: 3131987. DOI: 10.2147/CIA.S13423. View

Wagenlehner F, Naber K, Weidner W . Asymptomatic bacteriuria in elderly patients: significance and implications for treatment. Drugs Aging. 2005; 22(10):801-7. DOI: 10.2165/00002512-200522100-00001. View

Monroe T, Carter M . A retrospective pilot study of African-American and caucasian nursing home residents with dementia who died from cancer. J Pain Symptom Manage. 2010; 40(4):e1-3. PMC: 6602905. DOI: 10.1016/j.jpainsymman.2010.06.007. View

Monroe T, Carter M, Feldt K, Tolley B, Cowan R . Assessing advanced cancer pain in older adults with dementia at the end-of-life. J Adv Nurs. 2012; 68(9):2070-8. PMC: 5726999. DOI: 10.1111/j.1365-2648.2011.05929.x. View

Phillips C, Adepoju O, Stone N, Moudouni D, Nwaiwu O, Zhao H . Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes. BMC Geriatr. 2012; 12:73. PMC: 3534219. DOI: 10.1186/1471-2318-12-73. View

Tal S, Guller V, Levi S, Bardenstein R, Berger D, Gurevich I . Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection. J Infect. 2005; 50(4):296-305. DOI: 10.1016/j.jinf.2004.04.004. View

Nicolle L . Urinary tract infection in geriatric and institutionalized patients. Curr Opin Urol. 2001; 12(1):51-5. DOI: 10.1097/00042307-200201000-00010. View

Loeb M, Bentley D, Bradley S, Crossley K, Garibaldi R, Gantz N . Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol. 2001; 22(2):120-4. DOI: 10.1086/501875. View

Genao L, Buhr G . Urinary Tract Infections in Older Adults Residing in Long-Term Care Facilities. Ann Longterm Care. 2013; 20(4):33-38. PMC: 3573848. View

10.

Nicolle L . Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am. 1997; 11(3):647-62. DOI: 10.1016/s0891-5520(05)70378-0. View

11.

Nicolle L, Bradley S, Colgan R, Rice J, Schaeffer A, Hooton T . Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005; 40(5):643-54. DOI: 10.1086/427507. View

12.

Zabarsky T, Sethi A, Donskey C . Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control. 2008; 36(7):476-80. DOI: 10.1016/j.ajic.2007.11.007. View

13.

Gorbach S . Antibiotics and Clostridium difficile. N Engl J Med. 1999; 341(22):1690-1. DOI: 10.1056/NEJM199911253412211. View