Resident-Related Factors Influencing Antibiotic Treatment Decisions for Urinary Tract Infections in Dutch Nursing Homes

Abstract

The aim of this cohort study was to identify resident-related factors that influence antibiotic treatment decisions for urinary tract infections (UTIs) in nursing home residents and to provide an overview of the appropriateness of antibiotic treatment decisions according to the updated Dutch guideline for UTIs in frail older adults. The PROGRESS study dataset, consisting of 298 suspected UTI episodes in Dutch nursing home residents, was used. The presence of dysuria was associated with the highest frequency of antibiotic prescription (87.8%). Positive leukocyte esterase dipstick results showed the greatest increase in the risk of antibiotic prescription (RR 2.1, 95% CI 1.44 to 3.06). Treatment decisions were considered adequate in 64.1% of the suspected UTI episodes. Overtreatment occurred more often than undertreatment. Of the inadequate treatment decisions, 29.3% was due to treatment of UTI episodes in which solely non-specific symptoms were present. A high proportion of nitrofurantoin prescriptions were incorrect in UTIs with signs of tissue invasion (54.8%), indwelling catheter-associated UTIs (37.5%), and UTIs in men (29.2%). Although this is considered inadequate, non-specific symptoms were associated with antibiotic prescription for suspected UTIs in Dutch nursing home residents and nitrofurantoin was inadequately prescribed in particular groups, such as men.

Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: A discrete choice experiment

“…We chose this guideline due to its strong methodology, the participation of leaders in the field, the rigor in its development, the high rate of participation, 8 and its use in other work. 9,10 We fit a multilevel logistic model that tested the effect of the 9 clinical categories on odds of a false-positive diagnosis, adjusting for 7 preselected clinician characteristics (ie, age, sex, UTI knowledge, attitude toward reducing antibiotics, perceived external demand for antibiotics, perceived external influence for antibiotics, and years of experience) plus clinical role. The details of these clinician characteristics can be found in our prior work.…”

“…We chose this guideline due to its strong methodology, the participation of leaders in the field, the rigor in its development, the high rate of participation, 8 and its use in other work. 9,10…”