Urinary Tract Infection, Antibiotic Use
Conditions
Keywords
Urinary tract infections,, antibiotic use,, long term care facilities
Brief summary
The purpose of this study was to determine if a multi-faceted intervention to implement diagnostic and therapeutic algorithms for management of suspected urinary infection in nursing home residents could reduce antibiotic prescribing for urinary indications in this population.
Detailed description
Antibiotic use is intense in nursing homes and frequently inappropriate when prescribed for urinary indications. Evidence from randomized controlled trials suggests that treatment of asymptomatic bacteriuria, the presence of bacteria in the urine in the absence of urinary symptoms, is not beneficial. Despite this, one in three prescriptions for urinary indications are for asymptomatic bacteriuria. To improve antibiotic prescribing in this setting we conducted a cluster randomized trial of a strategy to implement diagnostic and treatment algorithms for urinary infection. 24 nursing homes were randomized to either the intervention (implemented at the nursing home level using a multi-faceted approach: small group interactive sessions for nurses, one-on-one interviews for physicians, videotapes, written material, and outreach visits) or to usual care.
Interventions
BEHAVIORALdiagnostic and treatment clinical algorithms
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
ECT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
0 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Individuals- all residents eligible 2. Nursing homes * Free standing long term care facilities with \>100 beds * No stated policy for diagnosis or treatment of urinary tract infections * The facility agrees to refrain from introducing new strategies for antibiotic utilization or clinical pathways during study
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Antimicrobial prescriptions | — |
Secondary
| Measure | Time frame |
|---|---|
| Urinary cultures, | — |
| hospitalizations, deaths | — |
Countries
Canada
Outcome results
None listed