Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 21;11(2):140.
doi: 10.3390/antibiotics11020140.

Resident-Related Factors Influencing Antibiotic Treatment Decisions for Urinary Tract Infections in Dutch Nursing Homes

Lisa Marie Kolodziej  1 , Sacha Daniëlle Kuil  1 , Menno Douwe de Jong  1 , Caroline Schneeberger  1
Affiliations

Resident-Related Factors Influencing Antibiotic Treatment Decisions for Urinary Tract Infections in Dutch Nursing Homes

Lisa Marie Kolodziej et al. Antibiotics (Basel). .

Abstract

The aim of this cohort study was to identify resident-related factors that influence antibiotic treatment decisions for urinary tract infections (UTIs) in nursing home residents and to provide an overview of the appropriateness of antibiotic treatment decisions according to the updated Dutch guideline for UTIs in frail older adults. The PROGRESS study dataset, consisting of 298 suspected UTI episodes in Dutch nursing home residents, was used. The presence of dysuria was associated with the highest frequency of antibiotic prescription (87.8%). Positive leukocyte esterase dipstick results showed the greatest increase in the risk of antibiotic prescription (RR 2.1, 95% CI 1.44 to 3.06). Treatment decisions were considered adequate in 64.1% of the suspected UTI episodes. Overtreatment occurred more often than undertreatment. Of the inadequate treatment decisions, 29.3% was due to treatment of UTI episodes in which solely non-specific symptoms were present. A high proportion of nitrofurantoin prescriptions were incorrect in UTIs with signs of tissue invasion (54.8%), indwelling catheter-associated UTIs (37.5%), and UTIs in men (29.2%). Although this is considered inadequate, non-specific symptoms were associated with antibiotic prescription for suspected UTIs in Dutch nursing home residents and nitrofurantoin was inadequately prescribed in particular groups, such as men.

Keywords: antibiotic prescribing; nursing homes; urinary tract infection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funder had no role in the design of this study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Baseline characteristics and adequate antibiotic prescriptions for suspected UTIs in Dutch nursing home residents. Baseline characteristics of the enrolled residents (n = 206) and suspected UTI episodes (n = 298) including proportions of adequate and inadequate treatment decisions according to Dutch guideline for UTIs in people who are frail and older [17]; adequate prescription: adequate prescription of antibiotics based on signs and symptoms justifying antibiotics; inadequate prescription: inadequate prescription based on signs and symptoms justifying antibiotics; adequately withheld: antibiotics adequately withheld based on signs and symptoms justifying antibiotics; inadequately withheld: antibiotics inadequately withheld based on signs and symptoms justifying antibiotics; UTI = urinary tract infection.
Figure 2
Figure 2
Antibiotic prescription in resident-related factor combinations for suspected UTI episodes in Dutch nursing home residents. Proportions of antibiotic prescriptions in the enrolled suspected UTI episodes (n = 298) per resident-related factor combination (both on x- and y-axis); light colours represent lower prescription proportions, while dark colours represent higher prescription proportions; UTI = urinary tract infection.
See this image and copyright information in PMC

References

    1. Pulia M., Kern M., Schwei R.J., Shah M.N., Sampene E., Crnich C.J. Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: A cross-sectional analysis. Antimicrob. Resist. Infect. Control. 2018;7:74. doi: 10.1186/s13756-018-0364-7. - DOI - PMC - PubMed
    1. Eriksen H., Iversen B., Aavitsland P. Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003. J. Hosp. Infect. 2005;60:40–45. doi: 10.1016/j.jhin.2004.09.038. - DOI - PubMed
    1. Engelhart S., Hanses-Derendorf L., Exner M., Kramer M. Prospective surveillance for healthcare-associated infections in German nursing home residents. J. Hosp. Infect. 2005;60:46–50. doi: 10.1016/j.jhin.2004.09.037. - DOI - PubMed
    1. Van Buul L.W., van der Steen J., Veenhuizen R., Achterberg W., Schellevis F.G., Essink R.T., van Benthem B.H., Natsch S., Hertogh C.M. Antibiotic Use and Resistance in Long Term Care Facilities. J. Am. Med Dir. Assoc. 2012;13:568.e1–568.e13. doi: 10.1016/j.jamda.2012.04.004. - DOI - PubMed
    1. Van Buul L.W., Veenhuizen R.B., Achterberg W.P., Schellevis F.G., Essink R.T.G.M., de Greeff S.C., Natsch S., van der Steen J.T., Hertogh C.M.P.M. Antibiotic Prescribing in Dutch Nursing Homes: How Appropriate Is It? J. Am. Med. Dir. Assoc. 2015;16:229–237. doi: 10.1016/j.jamda.2014.10.003. - DOI - PubMed

LinkOut - more resources