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Published on: August 30, 2018
Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a
Elisabeth König1, Lisa Kriegl1, Christian Pux2
1Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036, Graz, Austria.
Background:
Widespread inappropriate use of antimicrobial substances drives resistance development worldwide. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antimicrobial agents prescribed in LTCFs are for urinary tract infections (UTI). We aimed to increase the number of appropriate antimicrobial treatments for UTIs in LTCFs using a multi-faceted antimicrobial stewardship intervention.
Methods:
We performed a non-randomized cluster-controlled intervention study. Four LTCFs of the Geriatric Health Centers Graz were the intervention group, four LTCFs served as control group. The main components of the intervention were: voluntary continuing medical education for primary care physicians, distribution of a written guideline, implementation of the project homepage to distribute guidelines and videos and onsite training for nursing staff. Local nursing staff recorded data on UTI episodes in an online case report platform. Two blinded reviewers assessed whether treatments were adequate.
Results:
326 UTI episodes were recorded, 161 in the intervention group and 165 in the control group. During the intervention period, risk ratio for inadequate indication for treatment was 0.41 (95% CI 0.19-0.90), p = 0.025. In theintervention group, the proportion of adequate antibiotic choices increased from 42.1% in the pre-intervention period, to 45.9% during the intervention and to 51% in the post-intervention period (absolute increase of 8.9%). In the control group, the proportion was 36.4%, 33.3% and 33.3%, respectively. The numerical difference between intervention group and control group in the post-intervention period was 17.7% (difference did not reach statistical significance). There were no significant differences between the control group and intervention group in the safety outcomes (proportion of clinical failure, number of hospital admissions due to UTI and adverse events due to antimicrobial treatment).
Conclusions:
An antimicrobial stewardship program consisting of practice guidelines, local and web-based education for nursing staff and general practitioners resulted in a significant increase in adequate treatments (in terms of decision to treat the UTI) during the intervention period. However, this difference was not maintained in the post-intervention phase. Continued efforts to improve the quality of prescriptions further are necessary.
Trial Registration:
The trial was registered at ClinicalTrials.gov NCT04798365.
Insights
An antimicrobial stewardship intervention improved appropriate urinary tract infection (UTI) treatments in long-term care facilities (LTCFs) during the intervention period. However, the positive effects on UTI treatment quality were not sustained post-intervention, highlighting the need for ongoing efforts.
Area of Science:
- Geriatrics
- Infectious Diseases
- Public Health
Background:
- Inappropriate antimicrobial use fuels global resistance, with antibiotics frequently prescribed in long-term care facilities (LTCFs).
- Urinary tract infections (UTIs) account for over one-third of antibiotic prescriptions in LTCFs.
- Antimicrobial resistance poses a significant threat to public health, necessitating targeted interventions.
Purpose of the Study:
- To evaluate the effectiveness of a multi-faceted antimicrobial stewardship intervention aimed at increasing appropriate UTI treatments in LTCFs.
- To assess the impact of the intervention on the quality of antibiotic prescriptions for UTIs.
Main Methods:
- A non-randomized cluster-controlled study involving eight LTCFs, with four serving as the intervention group and four as the control.
- Intervention components included continuing medical education for physicians, guideline distribution, a project website, and on-site nursing staff training.
- Data on UTI episodes were collected via an online platform, with treatment adequacy assessed by blinded reviewers.
Main Results:
- The intervention group showed a significant reduction in the risk ratio for inadequate treatment indication (0.41, p=0.025).
- Adequate antibiotic choices for UTIs increased in the intervention group during and after the intervention period, but the difference was not statistically significant compared to the control group post-intervention.
- No significant differences were observed in clinical failure rates, hospital admissions due to UTI, or adverse events between the groups.
Conclusions:
- The antimicrobial stewardship program effectively increased adequate UTI treatments during the intervention phase.
- The positive impact on treatment quality was not sustained after the intervention concluded.
- Continuous strategies are essential to sustain and further improve antimicrobial prescribing quality in LTCFs.
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