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Assessment of potentially unnecessary antibiotic use for suspected urinary tract infections in nursing homes using a
Carl Llor1,2,3, Jonas Olsen3, Jesper Lykkegaard3
1Primary Care Research Institute Jordi Gol (IDIAP), Barcelona, Spain.
Background:
Nursing home (NH) residents are frequently treated with antibiotics for urinary tract infections (UTIs), often due to overdiagnosis. The aim of this study was to evaluate the proportion of potentially unnecessary antibiotic use for suspected UTIs in NHs across eight European countries.
Research Design And Methods:
Over a three-month period (February to April 2024), NH professionals recorded information on all antibiotic treatments for UTIs using a specific registration chart. Based on medical literature and the expertise of the project consortium members, the authors developed and endorsed by consensus a simplified algorithm to assess unnecessary antibiotic use in residents without indwelling catheters.
Results:
The study, conducted across 110 NHs, included 2773 antibiotic-treated infections. Of these, 1158 (41.8%) were treated for UTIs. Among 975 UTI cases without catheters, 54.1% may have been unnecessarily treated. Over one-third involved nonspecific symptoms including poor general condition and changes in urine appearance, while specific urinary symptoms, such as incontinence (21.3%) and dysuria (20.8%), were less common. A trend toward greater, potentially unnecessary antibiotic use was observed when urine dipsticks were performed.
Conclusions:
The findings reveal potentially unnecessary antibiotic use. Further algorithm validation is needed to enhance diagnostic criteria, reduce overuse, and improve UTI management in NHs.
Insights
Over half of urinary tract infection (UTI) antibiotic treatments in nursing home residents without catheters may be unnecessary. This highlights a need for improved diagnostic criteria to reduce antibiotic overuse in long-term care settings.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Pharmacology
Background:
- Nursing home residents frequently receive antibiotics for suspected urinary tract infections (UTIs).
- Overdiagnosis contributes to the overuse of antibiotics in this vulnerable population.
- This study addresses the significant issue of potentially unnecessary antibiotic use for UTIs in European nursing homes.
Purpose of the Study:
- To evaluate the proportion of potentially unnecessary antibiotic prescriptions for suspected UTIs in nursing home residents.
- To identify factors contributing to antibiotic overuse in this setting.
- To inform strategies for improving UTI diagnosis and management in nursing homes.
Main Methods:
- A prospective study conducted over three months (February-April 2024) across 110 nursing homes in eight European countries.
- Antibiotic treatments for UTIs were recorded using a specific registration chart.
- A consensus-based algorithm was developed to assess unnecessary antibiotic use in residents without indwelling catheters.
Main Results:
- Out of 2773 antibiotic-treated infections, 1158 (41.8%) were for UTIs.
- Among 975 UTI cases without catheters, 54.1% were potentially unnecessarily treated.
- Nonspecific symptoms (e.g., poor general condition) were common, while specific urinary symptoms were less frequent. Urine dipstick use correlated with increased potentially unnecessary antibiotic treatment.
Conclusions:
- A significant proportion of antibiotic use for UTIs in nursing home residents without catheters may be unnecessary.
- Current diagnostic criteria and practices require enhancement to reduce antibiotic overuse.
- Further validation of the developed algorithm is needed to improve UTI management in nursing homes.
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