National trends in the treatment of urinary tract infections among Veterans’ Affairs Community Living Center residents

Abstract

Objective:To describe urinary tract infection (UTI) treatment among Veterans’ Affairs (VA) Community Living Centers (CLCs) nationally and to assess related trends in antibiotic use.Design:Descriptive study.Setting and participants:All UTI episodes treated from 2013 through 2017 among residents in 110 VA CLCs. UTI episodes required collection of a urine culture, antibiotic treatment, and a UTI diagnosis code. UTI episodes were stratified into culture-positive and culture-negative episodes.Methods:Frequency and rate of antibiotic use were assessed for all UTI episodes overall and were stratified by culture-positive and culture-negative episodes. Joinpoint software was used for regression analyses of trends over time.Results:We identified 28,247 UTI episodes in 14,983 Veterans. The average age of Veterans was 75.7 years, and 95.9% were male. Approximately half of UTI episodes (45.7%) were culture positive and 25.7% were culture negative. Escherichia coli was recovered in 34.1% of culture-positive UTI episodes, followed by Proteus mirabilis and Klebsiella spp, which were recovered in 24.5% and 17.4% of culture-positive UTI episodes, respectively. The rate of total antibiotic use in days of therapy (DOT) per 1,000 bed days decreased by 10.1% per year (95% CI, −13.6% to −6.5%) and fluoroquinolone use (ciprofloxacin or levofloxacin) decreased by 14.5% per year (95% CI, −20.6% to −7.8%) among UTI episodes overall. Similar reductions in rates of total antibiotic use and fluoroquinolone use were observed among culture-positive UTI episodes and among culture-negative UTI episodes.Conclusion:Over a 5-year period, antibiotic use for UTIs significantly decreased among VA CLCs, as did use of fluoroquinolones. Antibiotic stewardship efforts across VA CLCs should be applauded, and these efforts should continue.

Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study

“…hospital or outpatient) previously. Figure 1 presents a flow chart of methods used to identify our study population [27,28]. Suspected UTIs required the collection of a urine culture (despite whether or not the culture was ultimately positive or negative for microbial growth) and an antibiotic given on the culture collection date or within 3 days after culture collection [27,28].…”

“…Figure 1 presents a flow chart of methods used to identify our study population [27,28]. Suspected UTIs required the collection of a urine culture (despite whether or not the culture was ultimately positive or negative for microbial growth) and an antibiotic given on the culture collection date or within 3 days after culture collection [27,28]. We excluded residents with a recent urologic procedure, female residents of childbearing age, those treated with antibiotics for over 30 days, those with other positive cultures, and those treated with any non-UTI or uncommon antibiotics.…”

Medications in Post-Acute and Long-Term Care: Challenges and Controversies

“…20 In response, antibiotic stewardship efforts aimed at reducing overprescribing are widely promoted, and some successes have been achieved. 21,22 In this issue of JAMDA, 3 articles report research relevant to better understanding some of the issues related to antibiotic overprescribing. Beeber et al 23 present research documenting how nurses are more likely to make decisions that do not follow prescribing guidelines when they have limited time; Hendricksen and colleagues 24 identify facility factors that are associated with increased prescribing in persons with advanced dementia; and Hanlon et al 25 report encouraging results from an intervention study to improve prescribing for suspected cystitis.…”

Antibiotic switch after treatment with UTI antibiotics in male patients

“…From 2012, there has been a steady decline of the use of fluoroquinolones and an increased use of cotrimoxazole. The reduction in overall antibiotic use in general, and fluoroquinolones in particular, is also seen in other countries [24], probably caused by the European and Norwegian stewardship programmes and guidelines, and a wanted shift from fluoroquinolones as empiric treatment in primary care due to increasing resistance and warnings about adverse effects [25,26]. Overall antibiotic sales in Norway have decreased by 24% since 2012 [2].…”