Impact of a decision-making aid for suspected urinary tract infections on antibiotic overuse in nursing homes

BMC Geriatrics

Research Article

Elizabeth Frentzel¹  Steven Garfinkel¹  Obioma Nwaiwu²  Charles D. Phillips²  Sara Imanpour²  Hongwei Zhao²  Darcy K. McMaughan³  David Mehr⁴ 

[1] American Institutes for Research, Washington, D.C, USA;Texas A&M University, College Station, USA;Texas A&M University, College Station, USA;Department of Health Policy & Management, School of Public Health, 1266 TAMU, 77843, College Station, TX, USA;University of Missouri School of Medicine, Columbia, USA;

关键词: Nursing home;    Antibiotic stewardship;    Urinary tract infection;    Asymptomatic bacteriuria;    Antibiotics;   

DOI  :  10.1186/s12877-016-0255-9

 received in 2015-11-17, accepted in 2016-04-09,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundAntibiotics are highly utilized in nursing homes. The aim of the study was to test the effectiveness of a decision-making aid for urinary tract infection management on reducing antibiotic prescriptions for suspected bacteriuria in the urine without symptoms, known as asymptomatic bacteriuria (ASB) in twelve nursing homes in Texas.MethodA pre- and post-test with comparison group design was used. The data was collected through retrospective chart review. The study sample included 669 antibiotic prescriptions for suspected urinary tract infections ordered for 547 nursing home residents. The main measurement for the outcome variable was whether an antibiotic was prescribed for suspected urinary tract infections with no symptoms present.ResultsMost of the prescriptions for antibiotics UTIs were written without documented symptoms – thus for asymptomatic bacteuria (ASB) (71 % during the pre-intervention period). Exposure to the decision-making aid decreased the number of prescriptions written for ASB (from 78 % to 65 % in the low-intensity homes and from 65 % to 57 % in the high-intensity homes), and decreased odds of a prescription being written for ASB (OR = 0.63, 95 % CI = 0.25 – 1.60 for low-intensity homes; OR = 0.79, 95 % CI = 0.33 – 1.88 for high-intensity homes). The odds of a prescription being written for ASB decreased significantly in homes that succeeded in implementing the decision-making aid (OR = 0.35, 95 % CI = 0.16–0.76), compared to homes with no fidelity.ConclusionsThe decision-making aid improved antibiotic stewardship in nursing homes.

【 授权许可】

CC BY   
© McMaughan et al. 2016