Urinary Tract Infections (UTIs) are most common in nursing home residents, but inappropriate use of antibiotics use for presumed cystitis (characterized by non-specific symptoms and positive culture results suggestive of asymptomatic bacteriuria or an improperly collected urine sample) is also frequently encountered. Problematic antibiotic use in nursing homes is associated with an increased risk of antimicrobial resistance, adverse drug events, and Clostridioides difficile (formerly Clostridium difficile) infections. Researchers have recently assessed whether a multifaceted antimicrobial stewardship program and quality improvement intervention to reduce unnecessary antimicrobial use for cases where cystitis is actually unlikely might impact upon this issue for non-catheterized nursing home residents. The study was conducted in 25 nursing homes across the United States, comparing 12 facilities that received an intervention (a 1-hour introductory webinar, pocket-sized educational cards, tools for system change, and educational clinical vignettes addressing the diagnosis and treatment of suspected uncomplicated cystitis, plus monthly web-based coaching calls for staff) to control group facilities (n = 13) that received usual care. The study covered 512 408 intervention facility resident-days and 443 912 control facility resident-days
Fewer unlikely cystitis cases were treated with antibiotics in intervention facilities compared with control facilities (adjusted incident rate ratio [AIRR], 0.73 [95% CI, 0.59-0.91]), and C difficile infection rates were also lower in intervention nursing homes vs control nursing homes (AIRR, 0.35 [95% CI, 0.19-0.64]). Overall antibiotic use for any type of urinary tract infection was 17% lower in the intervention facilities than the control facilities (AIRR, 0.83 [95% CI, 0.70-0.99]; P = .04). There was no increase in all-cause hospitalizations or deaths due to the intervention (all-cause hospitalizations: AIRR, 0.95 [95% CI, 0.75-1.19]; all-cause death: AIRR, 0.92 [95% CI, 0.73-1.16]).
There is scope to replicate this research on a wider basis, with a view to exploring ways to better manage an issue that is very commonly encountered in the aged care setting. More details of the study, published in the JAMA, can be viewed here.