IMPROVING THE MANAGEMENT OF ASYMPTOMATIC BACTERIURIA IN OLDER ADULTS IN LONG-TERM CARE

Abstract

Abstract Problem: The unnecessary or inappropriate use of prescription antibiotics is a public health problem. An estimated 40% to 75% of antibiotics prescribed in U.S. nursing homes may be unwarranted, and moreover, the most commonly treated infection in nursing homes is a urinary tract infection (UTI). Up to one-third to one-half of prescriptions used to treat suspected UTIs in nursing home residents are actually aimed at asymptomatic bacteriuria (ASB). Consistent findings show the treatment of ASB is unnecessary and can be harmful, leading to increased rates of Clostridium difficile, multidrug resistant organisms, adverse drug events, hospital admissions, and higher health care costs. The Centers for Disease Control and Prevention (CDC) recommends that all nursing homes take steps to improve antibiotic prescribing practices through the utilization of antibiotic stewardship activities. The CDC defines antibiotic stewardship as a set of commitments and actions designed optimize the treatment of infections while reducing adverse events associated with antibiotic use. Project Aim: The purpose of this quality improvement project was to assess if the implementation of an antibiotic stewardship program in the nursing home setting decreases the rate of antibiotics prescribed for ASB in older adults. Project Method: A retrospective chart review of data was utilized to record baseline rates of antibiotics prescribed for UTIs and ASB. The chart review included the analysis of nursing notes, progress notes, provider visits, and nursing home infection logs to determine if an antibiotic was prescribed for a symptomatic UTI versus ASB. An antibiotic stewardship program consisting of an educational session about antibiotic stewardship and a decision-making tool was implemented and utilized by nurses and providers. Recommendations regarding antibiotic prescribing practices for suspected UTIs and a toolkit for suspected UTIs developed by the Agency for Healthcare Research and Quality served as core elements of the antibiotic stewardship program. The rate of antibiotics prescribed for UTIs and ASB was evaluated and compared to baseline data at two months. Project Results: Baseline data revealed that 64% of antibiotic prescriptions written for suspected UTIs were aimed at ASB. Exposure to the antibiotic stewardship program decreased the rate of antibiotic prescriptions written for ASB by 18%, as the rate of antibiotics written for ASB in the post intervention period was 46%. Conclusion: The antibiotic stewardship program and decision-making tool decreased the rate of antibiotics prescribed for ASB in older adults in the long-term care setting.