Optimizing Antibiotic Use in Long Term Care

Agency for Healthcare Research and Quality (AHRQ)

Status

Completed

Conditions

Urinary Tract Infection, Antibiotic Use

Treatments

Behavioral: diagnostic and treatment clinical algorithms

Study type

Interventional

Funder types

Other U.S. Federal agency

Identifiers

NCT00243360

U18HS011113-01

Details and patient eligibility

About

The purpose of this study was to determine if a multi-faceted intervention to implement diagnostic and therapeutic algorithms for management of suspected urinary infection in nursing home residents could reduce antibiotic prescribing for urinary indications in this population.

Full description

Antibiotic use is intense in nursing homes and frequently inappropriate when prescribed for urinary indications. Evidence from randomized controlled trials suggests that treatment of asymptomatic bacteriuria, the presence of bacteria in the urine in the absence of urinary symptoms, is not beneficial. Despite this, one in three prescriptions for urinary indications are for asymptomatic bacteriuria. To improve antibiotic prescribing in this setting we conducted a cluster randomized trial of a strategy to implement diagnostic and treatment algorithms for urinary infection. 24 nursing homes were randomized to either the intervention (implemented at the nursing home level using a multi-faceted approach: small group interactive sessions for nurses, one-on-one interviews for physicians, videotapes, written material, and outreach visits) or to usual care.

Sex

All

Volunteers

No Healthy Volunteers

Inclusion criteria

Individuals- all residents eligible
Nursing homes
- Free standing long term care facilities with >100 beds
- No stated policy for diagnosis or treatment of urinary tract infections
- The facility agrees to refrain from introducing new strategies for antibiotic utilization or clinical pathways during study

Exclusion criteria