Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention

Zabarsky, Trina F.; Sethi, Ajay K.; Donskey, Curtis J.

doi:10.1016/j.ajic.2007.11.007

Cited by 125 publications

(174 citation statements)

References 13 publications

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“…McClean et al reported the results of two point-prevalence surveys conducted in residential homes in Northern Ireland, where only 58-70% and 40-44% of systemic and topical antimicrobials respectively were initiated following GP visits [6]. In an American study, physicians reported that they often prescribed treatment for UTIs without seeing the patients and depended on the nursing staff to provide information regarding symptoms and signs of a UTI [29]. A Canadian study also showed that only 44% of the antibiotic recipients had an associated claim for a physician bedside visit within 1 day of their index prescription [10].…”

Section: Medical and Nursing Staffmentioning

confidence: 95%

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Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.

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Section: Medical and Nursing Staffmentioning

confidence: 95%

“…Previous research has shown that in the long-term care environment, nursing staff can be the driving force behind antibiotic prescribing [6,7,10,25,28,29]. Physicians often rely on the nursing staff's assessment of the resident and may not visit a patient in an LTCF to confirm diagnosis.…”

Section: Medical and Nursing Staffmentioning

confidence: 97%

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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“…Interventional studies [12][13][14][15][16][17][18] have addressed the issue of inappropriate treatment of ASB. The Kicking CAUTI: The No Knee-Jerk Antibiotics Campaign built on previous interventions, with a novel focus on reducing urine culture ordering because positive urine cultures are powerful stimuli for antibiotic use.…”

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confidence: 99%

Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter–Associated Asymptomatic Bacteriuria

et al. 2015

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IMPORTANCE Overtreatment of asymptomatic bacteriuria (ASB) in patients with urinary catheters remains high. Health care professionals have difficulty differentiating cases of ASB from catheter-associated urinary tract infections.OBJECTIVES To evaluate the effectiveness and sustainability of an intervention to reduce urine culture ordering and antimicrobial prescribing for catheter-associated ASB compared with standard quality improvement methods. DESIGN, SETTING, AND PARTICIPANTSA preintervention and postintervention comparison with a contemporaneous control group from July 2010 to June 2013 at 2 Veterans Affairs health care systems. Study populations were patients with urinary catheters on acute medicine wards and long-term care units and health care professionals who order urine cultures and prescribe antimicrobials.INTERVENTION A multifaceted guidelines implementation intervention. MAIN OUTCOMES AND MEASURESThe primary outcomes were urine cultures ordered per 1000 bed-days and cases of ASB receiving antibiotics (overtreatment) during intervention and maintenance periods compared with baseline at both sites. Patient-level analysis of inappropriate antimicrobial use adjusted for individual covariates.RESULTS Study surveillance included 289 754 total bed-days. The overall rate of urine culture ordering decreased significantly during the intervention period (from 41.2 to 23.3 per 1000 bed-days; incidence rate ration [IRR], 0.57; 95% CI, 0.53-0.61) and further during the maintenance period (to 12.0 per 1000 bed-days; IRR, 0.29; 95% CI, 0.26-0.32) (P < .001 for both). At the comparison site, urine cultures ordered did not change significantly across all 3 periods. There was a significant difference in the number of urine cultures ordered per month over time when comparing the 2 sites using longitudinal linear regression (P < .001). Overtreatment of ASB at the intervention site fell significantly during the intervention period (from 1.6 to 0.6 per 1000 bed-days; IRR, 0.35; 95% CI, 0.22-0.55), and these reductions persisted during the maintenance period (to 0.4 per 1000 bed-days; IRR, 0.24; 95% CI, 0.13-0.42) (P < .001 for both). Overtreatment of ASB at the comparison site was similar across all periods (odds ratio, 1.32; 95% CI, 0.69-2.52). When analyzed by type of ward, the decrease in ASB overtreatment was significant in long-term care. CONCLUSIONS AND RELEVANCEA multifaceted intervention targeting health care professionals who diagnose and treat patients with urinary catheters reduced overtreatment of ASB compared with standard quality improvement methods. These improvements persisted during a low-intensity maintenance period. The impact was more pronounced in long-term care, an emerging domain for antimicrobial stewardship.

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“…12 Antibiotic stewardship interventions in long-term care have had promising but inconsistent effects on antibiotic use. [13][14][15] Prior initiatives have usually been multifaceted and have included educational sessions, [16][17][18][19][20][21] development of local guidelines, 16,17,[21][22][23] portable reference material, 16,19,23 on-site consultations about infectious diseases 24 or academic detailing. 18 Many of these interventions are labour intensive, and none have reported on cost-effectiveness or sustainability.…”

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confidence: 99%

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities

Daneman

Campitelli

Giannakeas

et al. 2017

CMAJ

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Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention

Cited by 125 publications

References 13 publications

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter–Associated Asymptomatic Bacteriuria

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities

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