Background: Antibiotic misuse contributes to the widespread emergence of antibiotic- resistant bacteria. Inappropriate antibiotic treatments for urinary tract infections (UTI) among nursing home (NH) residents is well documented, but evidence about the accuracy of diagnosis and treatment amongst residents transitioning between hospitals and NHs is lacking. UTI diagnosis differs in NH residents due to widespread presence of asymptomatic bacteriuria (ASB), the colonization of bacteria within the urinary tract. The Infectious Disease Society of America strongly advises against antibiotic treatment of ASB. However, differentiating ASB from UTI has been challenging. Additionally, appropriate care for patients with UTI has been found to be hindered by lack of communication between sites. The purpose of this study is to assess if discharge documents of hospitalized NH residents treated for UTI supported appropriate diagnosis and treatment using signs, symptoms, laboratory results, and prescription reviews.
Methods: A retrospective chart review was conducted with convenience samples in 3 NHs and 4 hospitals in southeast Michigan over a 3-year period. Electronic medical record (EMR) data were abstracted for residents with a diagnosis of UTI. An evidence-based tool and inter-rater agreement were used to determine antibiotic appropriateness.
Results: A total of 79 hospitalized residents were treated for a diagnosis of UTI. Of those, 18 (22.8%) were appropriately treated. Non-catheterized residents were treated appropriately 13% of the time with catheterized residents appropriately treated 56% of the time. There was a significant difference in lengths of stays between hospitals and NHs. Some findings were impacted by missing communication and documentation between sites.
Conclusions: Appropriate treatment rates amongst hospitalized NH residents appears to be low. The use of a consistent process to facilitate communication and documentation is missing. A comprehensive approach to improve assessment of UTI may improve appropriate treatments. Implementation and further assessments are planned.