Implementation of a Urinary Tract Infection Treatment Protocol to Improve Prescribing Practices in the Long-Term Care Facility of a Veteran's Healthcare System.

Spencer H. Durham,Addison H. Ragan,Natalie S. Hohmann

doi:10.3390/pharmacy8030129

Spencer H. Durham, Addison H. Ragan + Show 1 more

Open Access

https://doi.org/10.3390/pharmacy8030129

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Abstract

Urinary tract infections (UTIs) are a commonly diagnosed problem in long-term care facilities (LTCFs), but antimicrobial treatment is often incorrectly prescribed. Although bacterial resistance to antimicrobials commonly used for UTIs, such as trimethoprim/sulfamethoxazole and fluoroquinolones, has been dramatically increasing, they are still commonly prescribed. The purpose of this project was to determine if implementation of a standard treatment protocol for UTIs, which emphasized correct UTI diagnosis and use of nitrofurantoin and cefpodoxime/ceftriaxone as empiric therapy per the institutional antibiogram, changed clinician prescribing practices. This quasi-experimental model utilized two years of pre-intervention and two years of post-intervention data. Three hundred patient encounters were included. Antibiotics prescribed in the pre-intervention period included: trimethoprim/sulfamethoxazole (32%), ciprofloxacin (14%), amoxicillin (13%), levofloxacin (9%), cefpodoxime (9%), ceftriaxone (8%), amoxicillin/clavulanate (5%), nitrofurantoin (4%), and other (6%). By contrast, antibiotics prescribed in the post-intervention period included: cefpodoxime (46%), nitrofurantoin (30%), ceftriaxone (10%), trimethoprim/sulfamethoxazole (8%), amoxicillin/clavulanate (1%), and other (5%). These differences in prescribed drug between the pre-intervention and post-intervention encounters were statistically significant (p < 0.001). Overall, appropriate empiric treatment was prescribed in only 48/217 encounters (22%) during the pre-intervention period, but this increased to 73/83 encounters (88%) in the post-intervention period (p < 0.001). The results indicate that the treatment protocol was successful in changing prescribing practices and decreasing the use of inappropriate antimicrobials at the LTCF.

Highlights

Infections are a common diagnosis in long-term care facilities (LTCFs), with as many as three million infections diagnosed each year [1]
Urinary tract infections (UTIs) are one of the most common infections diagnosed in LTCFs, accounting for up to 20% of infections [4]
Patients in LTCFs may be at a higher risk of UTIs for a variety of reasons, including advanced age, underlying immune suppression, and other disease states that may predispose to UTIs, such as benign prostatic hyperplasia [4,5]

Summary

Introduction

Infections are a common diagnosis in long-term care facilities (LTCFs), with as many as three million infections diagnosed each year [1]. The Centers for Disease Control and Prevention (CDC) estimate that up to 70% of LTCF residents receive at least one course of an antibiotic in a one-year period [2]. Patients in LTCFs may be at a higher risk of UTIs for a variety of reasons, including advanced age, underlying immune suppression, and other disease states that may predispose to UTIs, such as benign prostatic hyperplasia [4,5]. Another major risk factor for UTIs in this population is the presence of an indwelling urinary catheter. Almost all patients with indwelling urinary catheters become bacteriuric within one month of catheter insertion, bacteriuria is often not associated with infection [6]

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