Objectives To evaluate the use of diagnostic testing prior to treating an infection in nursing home (NH) residents with indwelling devices suspected of having a urinary tract infection (UTI) or pneumonia. Design Prospective longitudinal study nested within a randomized trial Setting Six NHs in Southeast Michigan Participants 162 NH residents with an indwelling urinary catheter and/or enteral feeding tube with 695 follow-up visits [189/695 (28%) visits with an infection]. Measurements Patient-specific clinical and demographic data—including information on incident infections, antibiotic use, and results of diagnostic tests—were obtained at study enrollment, after 14 days, and monthly thereafter for up to one year. Results : More than half (100/162 [62%]) of NH residents with indwelling devices had an incident infection requiring antibiotics, with substantial variations between NHs. Besides presence of infection-specific symptoms, change in function was a significant predictor for ordering a chest x-ray to detect pneumonia (OR = 1.7; P = 0.01). Similarly, change in mentation was a significant predictor for ordering a UA (OR = 1.9; P = 0.02), chest x-ray (OR = 3.3; P < 0.01), and blood culture (OR = 2.3; P = 0.02). Empiric antibiotic use before having laboratory data occurred in 50 of 233 suspected UTI (21.5%) and 16 of 53 (30.2%) suspected pneumonia. Antibiotics were used in 17% of visits without documented clinical or laboratory evidence of infection. Conclusion In this study nested within a cluster randomized trial and using data from control sites, we show that constitutional symptoms such as change in function and mentation commonly lead to diagnostic testing with subsequent antibiotic prescribing. Antibiotic use often continues despite negative test results and should be a target for future interventions.

No abstract

No abstract

No abstract

No abstract