Epidemiology of Antibiotic Use for Urinary Tract Infection in Nursing Home Residents

被引：23

作者：

Thompson, Nicola D. ^{[1
]}

Penna, Austin ^{[1
]}

Eure, Taniece R. ^{[1
]}

Bamberg, Wendy M. ^{[2
]}

Barney, Grant ^{[3
]}

Barter, Devra ^{[2
]}

Clogher, Paula ^{[4
,5
]}

DeSilva, Malini B. ^{[6
]}

Dumyati, Ghinwa ^{[3
,7
]}

Epson, Erin ^{[8
]}

Frank, Linda ^{[9
]}

Godine, Deborah ^{[9
]}

Irizarry, Lourdes ^{[10
]}

Kainer, Marion A. ^{[11
]}

Li, Linda ^{[12
]}

Lynfield, Ruth ^{[6
]}

Mahoehney, J. P. ^{[6
]}

Nadle, Joelle ^{[9
]}

Ocampo, Valerie ^{[13
]}

Perry, Lewis ^{[14
]}

Ray, Susan M. ^{[14
,15
]}

Davis, Sarah Shrum ^{[10
]}

Sievers, Marla ^{[10
]}

Wilson, Lucy E. ^{[12
]}

Zhang, Alexia Y. ^{[13
]}

Stone, Nimalie D. ^{[1
]}

Magill, Shelley S. ^{[1
]}

机构：

[1] Ctr Dis Control & Prevent, Div Healthcare Qual Promot, 1600 Clifton Rd, Atlanta, GA 30329 USA

[2] Colorado Dept Publ Hlth & Environm, Denver, CO USA

[3] New York Emerging Infect Program, Rochester, NY USA

[4] Connecticut Emerging Infect Program, New Haven, CT USA

[5] Yale Sch Publ Hlth, New Haven, CT USA

[6] Minnesota Dept Hlth, St Paul, MN USA

[7] Univ Rochester, Rochester, NY USA

[8] Calif Dept Hlth, Richmond, CA USA

[9] Calif Emerging Infect Program, Oakland, CA USA

[10] New Mexico Dept Hlth, Santa Fe, NM USA

[11] Tennessee Dept Hlth, Nashville, TN USA

[12] Maryland Dept Hlth, Baltimore, MD USA

[13] Oregon Hlth Author, Portland, OR USA

[14] Georgia Emerging Infect Program, Atlanta, GA USA

[15] Emory Univ, Atlanta, GA 30322 USA

来源：

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION | 2020年 / 21卷 / 01期

关键词：

Antibiotic; urinary tract infection; nursing home;

D O I：

10.1016/j.jamda.2019.11.009

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Objectives: Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. Design: Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. Setting and participants: Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). Methods: EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. Results: Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. Conclusions and Implications: One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was >= 7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.

引用

页码：91 / 96

页数：6

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