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Published on: June 24, 2025
Correlations between quality ratings of skilled nursing facilities and multidrug-resistant urinary tract infections
Azad L Gucwa1, Veronika Dolar2, Chao Ye1
1Department of Biomedical Sciences, Long Island University, Brookville, NY.
Background:
The purpose of this study was to determine risk factors for the acquisition of urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs) in residents of skilled nursing facilities (SNFs).
Methods:
Using the informational database provided by the Centers for Medicare and Medicaid Services (CMS), a retrospective logistic regression was performed on 1,523 urine cultures from 12 SNFs located in Long Island, New York.
Results:
Of the 1,142 positive urine cultures, Escherichia coli was most prevalent. Additionally, 164 (14.4%) of the UTIs were attributed to an MDRO. In multivariate logistic regression, sex and overall quality rating predicted the occurrence of UTIs, whereas identification of MDROs was dependent on the level of nursing care received. The mean predicted probability of UTIs and receipt of contaminated samples was inversely dependent on the facility's rating, where the likelihood increased as overall quality ratings decreased.
Conclusions:
The CMS's quality rating system may provide some insight into the status of infection control practices in SNFs. The results of this study suggest that potential consumers should focus on the overall star ratings and the competency of the nursing staff in these facilities rather than on individual quality measures.
Insights
Skilled nursing facility residents with lower quality ratings face higher risks of urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs). Facility star ratings and nursing staff competence are key indicators for infection control.
Area of Science:
- Infectious Diseases
- Healthcare Quality
- Gerontology
Background:
- Urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs) pose significant health risks in skilled nursing facilities (SNFs).
- Understanding risk factors is crucial for improving patient outcomes and infection control in SNFs.
Purpose of the Study:
- To identify risk factors associated with acquiring UTIs and MDROs among residents in SNFs.
- To explore the relationship between facility quality metrics and infection rates.
Main Methods:
- Retrospective analysis of 1,523 urine cultures from 12 SNFs in Long Island, New York.
- Utilized data from the Centers for Medicare and Medicaid Services (CMS) database.
- Employed multivariate logistic regression to identify predictors of UTIs and MDRO acquisition.
Main Results:
- Escherichia coli was the most common pathogen in positive urine cultures.
- 14.4% of UTIs were caused by MDROs.
- Female sex and lower overall facility quality ratings were significant predictors of UTIs. MDRO identification correlated with the level of nursing care received.
Conclusions:
- The CMS quality rating system may reflect infection control practices within SNFs.
- Lower facility star ratings correlate with increased likelihood of UTIs and contaminated samples.
- Consumers should prioritize overall facility ratings and nursing staff competence when selecting SNFs.
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