Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents

Abstract

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH. Infect Control Hosp Epidemiol 2017;38:998-1001.

FIGURE 1.

Appropriateness of antibiotic initiation in nursing-home residents for therapeutic treatment of urinary tract infection (n = 33).(a) Microbiologic subcriteria includes at least 10⁵ cfu/mL of no more than 2 species of microorganisms in a voided urine sample or 10⁵ cfu/mL of any organism from a urinary catheter specimen. (b) McGeer warning signs of an infection for all residents include fever (single oral temperature of >100°F [37.8°C] or repeated oral temperatures >99°F [> 37.5°C] or rectal temperatures >99.5°F [> 37.5°C] or single temperature >2°C [1.1°C] over baseline from any site), leukocytosis, rigors, new onset of hypotension, and only for residents with an indwelling urinary catheter, delirium, purulent discharge, or suprapubic pain or tenderness. (c) McGeer localizing signs and symptoms for all residents include acute dysuria or acute pain, swelling, or tenderness of the testes, epididymis, or prostate, increased urgency, increased frequency, gross hematuria, acute costovertebral angle pain or tenderness, or increased incontinence, and only for residents without an indwelling urinary catheter, suprapubic pain. (d) Loeb warning signs of infection for all residents include fever (>100°F [37.9°C] or an increase of 2.4°F [1.5°C] above baseline temperature), and only for residents with an indwelling urinary catheter rigors, delirium, or costovertebral tenderness. (e) Loeb localizing signs and symptoms for all residents include new or worsening urgency, frequency, suprapubic pain, gross hematuria, or dysuria, and only for residents without an indwelling urinary catheter, costovertebral angle tenderness. (f) Crnich localizing signs and symptoms for all residents include acute dysuria, new urgency, frequency, or incontinence, acute gross hematuria, costovertebral tenderness, suprapubic pain, new scrotal/prostate tenderness, or purulent urethral discharge. (g) Crnich warning signs of an infection for all residents include fever (as defined by McGeer Criteria), rigors, delirium, unstable vital signs, which were defined as decreased oxygenation, respiratory rate ≥25 breaths per minute, or new onset of hypotension. (h) Delirium is defined as an acute mental status change plus altered level of consciousness and disorganized thinking.