Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

Aliyu, Sainfer; Travers, Jasmine; Heimlich, S. Layla; Ifill, Joanne; Smaldone, Arlene

doi:10.1177/07334648211018299

Cited by 13 publications

(9 citation statements)

References 49 publications

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“…42 support algorithms, particularly for UTIs, were the most effective. 43 Sadly, another systematic review found that evidence for electronic clinical decision support in NHs is observational and limited in quality. 44 Electronic clinical decision supports represents an untested but promising path forward to address decision-making deficits in NH clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Research in other clinical settings such as hospitals demonstrates that clinical decision support improves the diagnosis of infections and antibiotic prescribing, 40,41 including point‐of‐care clinical decision support, with moderate success 42 . A systematic review of NH antimicrobial stewardship interventions found that educational efforts and clinical decision support algorithms, particularly for UTIs, were the most effective 43 . Sadly, another systematic review found that evidence for electronic clinical decision support in NHs is observational and limited in quality 44 .…”

Section: Discussionmentioning

confidence: 99%

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Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline

Kistler

Wretman

Zimmerman

et al. 2022

J American Geriatrics Society

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Purpose: To inform overprescribing and antibiotic stewardship in nursing homes (NHs), we examined the concordance between clinicians' (NH primary care providers and registered nurses) diagnosis of suspected UTI with a clinical guideline treated as the gold standard, and whether clinician characteristics were associated with diagnostic classification.Methods: We conducted a cross-sectional web-based survey of a U.S. national convenience sample of NH clinicians. The survey included a discrete choice experiment with 19 randomly selected clinical scenarios of NH residents with possible UTIs. For each scenario, participants were asked if they thought a UTI was likely. Responses were compared to the guideline to determine the sensitivity and specificity of clinician judgment and performance indicators. Multivariable logistic mixed effects regression analysis of demographic, work, personality, and UTI knowledge/attitudes characteristics was conducted. Results: One thousand seven hundred forty-eight NH clinicians responded to 33,212 discrete choice scenarios; 867 (50%) were NH primary care providers and 881 (50%) were NH registered nurses, 39% were male, and the mean age was 45 years. Participants were uncertain about diagnosis in 30% of scenarios.Correct classification occurred for 66% of all scenarios (providers: 70%; nurses: 62%). Respondent judgment had a sensitivity of 78% (providers: 81%; nurses: 74%) and specificity of 54% (providers: 59%; nurses: 49%) compared to the clinical guideline. Adjusting for covariates in multivariable models, being a nurse and having higher closemindedness were associated higher odds of false positive UTI (odds ratio [OR] 1.61, p < 0.001; and OR 1.09, p = 0.039, respectively), although higher UTI knowledge and conscientiousness were associated with lower odds of false positive UTI ratings (OR 0.80, p < 0.001; OR 0.90, p = 0.005, respectively).Conclusions: Clinicians tend to over-diagnose urinary tract infections, necessitating systems-based interventions to augment clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline

Kistler

Wretman

Zimmerman

et al. 2022

J American Geriatrics Society

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“…Antimicrobials are often used in the residents who do not meet clinical criteria for UTI in the nursing homes [34]. Nursing homes with more occupied beds and higher number of admissions might have a higher rate of inappropriate use of antimicrobials and the interventions of ABS might help improve the treatment of infections for the residents in the nursing homes [35]. The application of ABS might improve the nursing quality in these nursing homes with large numbers of occupied beds and admissions.…”

Section: Discussionmentioning

confidence: 99%

Nursing Management-Associated Factors Associated with Urinary Tract Infection in Residents from Nursing Home Based on LTCfocus Database

Wang¹,

Wang²

2022

Urol Int

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Introduction: The aim of the study was to identify nursing management-associated factors correlated with urinary tract infection (UTI) in residents from nursing homes. Methods: The data of 3,393 nursing homes were extracted from LTCfocus database. Variables statistically correlated with UTI rate were identified by Spearman correlation analysis. Tobit regression model was used for finding the factors associated with UTI rate. Results: The number of beds (β = 0.03, 95% CI: 0.02–0.05), number of occupied beds/the total number of beds (β = 0.05, 95% CI: 0.03–0.07), number of admissions/total number of beds (β = 0.27, 95% CI: 0.11–0.43), the proportions of residents whose primary support is Medicare (β = 0.03, 95% CI: 0.01–0.06), women residents (β = 0.04, 95% CI: 0.02–0.06), White residents (β = 0.02, 95% CI: 0.01–0.03), patients with bladder incontinence (β = 0.03, 95% CI: 0.02–0.05), hypertension patients (β = 0.03, 95% CI: 0.01–0.05), and long-stay residents with daily pain (β = 0.16, 95% CI: 0.12–0.19), hospitalizations per resident year (β = 0.76, 95% CI: 0.30–1.21), and average daily census (β = −0.02, 95% CI: −0.03 to 0.00) were factors associated with UTI rate. Conclusions: Nursing homes with more females, White people, and patients with bladder incontinence, hypertension, or daily pain should be cared more and the number of occupied beds and admissions should be controlled to reduce the occurrence of UTI.

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“…Improving antibiotic use in the care of the institutionalized elderly in order to protect residents and reduce the threat of antibiotic resistance is a global priority. The Centers for Disease Control (CDC) and others recommends that all nursing homes take steps to improve antibiotic prescribing practices and reduce inappropriate antibiotic use [7][8][9][10].…”

Section: Is It Necessary For Each Ltcf To Have a Physician Or Nurse R...mentioning

confidence: 99%

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain

Bouza

Navarro²,

Alonso³

et al. 2023

Rev Esp Quimioter

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A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a “nosocomiun”, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

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Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

Cited by 13 publications

References 49 publications

Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline

Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline

Nursing Management-Associated Factors Associated with Urinary Tract Infection in Residents from Nursing Home Based on LTCfocus Database

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain

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