Urine cultures in a long-term care facility (LTCF): time for improvement

被引:12
作者
Haaijman, J. [1 ]
Stobberingh, E. E. [2 ]
van Buul, L. W. [3 ,4 ]
Hertogh, C. M. P. M. [3 ,4 ]
Horninge, H. [1 ]
机构
[1] River Reg Elderly Care Ctr SZR, Burgemeester Meslaan 49, NL-4003 CA Tiel, Netherlands
[2] Maastricht Univ, Sch Publ Hlth & Primary Care CAPHRI, Fac Hlth Med & Life Sci, Med Ctr,Dept Med Microbiol, Maastricht, Netherlands
[3] Vrije Univ Amsterdam Med Ctr, Amsterdam Publ Hlth Res Inst, NL-1081 BT Amsterdam, Netherlands
[4] Vrije Univ Amsterdam Med Ctr, Dept Gen Practice & Old Age Med, NL-1081 BT Amsterdam, Netherlands
来源
BMC GERIATRICS | 2018年 / 18卷
关键词
Urine cultures; Long-term care facilities; Urinary tract infection; Antibiotics; TRACT-INFECTIONS; ANTIBIOTIC USE; PREVALENCE; RESIDENTS; CRITERIA; WOMEN;
D O I
10.1186/s12877-018-0909-x
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
Background: Urinary tract infections (UTIs) are the most prevalent infections in long-term care facilities (LTCFs). Numerous studies have described the problem of inadequate UTI diagnosis and treatment. We assessed the role of urine cultures in the diagnosis and treatment of UTIs in a LTCF. Methods: In a 370-bed non-academic LTCF a retrospective assessment of antibiotic (AB) prescriptions for UTIs and urine cultures was performed from July 2014 to January 2016. The reasons why physicians, including 11 nursing home physicians and 2 junior doctors, ordered urine cultures were recorded using questionnaires. Results: During the study period, 378 residents were prescribed 1672 AB courses; 803 were for UTIs. One hundred and fifty-five urine cultures were obtained from 135 residents; 66 of these cultures were performed on the same day as ABs were prescribed (8% of all prescriptions for UTI), while 89 were not. There was a discrepancy between the actions that seemed logical based on the culture results and the actions that were actually taken in 75% of the cases. In these cases, initial AB treatment was not adjusted when the isolated microorganism was resistant to the AB prescribed, the urine culture was positive and no ABs had previously been administered, or ABs were prescribed and no microorganism was isolated. The most frequent reason for ordering a urine culture was to confirm the diagnosis of a UTI. Conclusion: In the majority of patients, AB therapy was not adjusted when the urine culture results suggested it may be appropriate. The physicians were erroneously convinced that UTIs could be diagnosed by a positive urine culture.
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页数:7
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共 34 条
  • [1] [Anonymous], 2014, Antimicrobial resistance: global report on surveillance
  • [2] Detection of urinary tract infection (UTI) in long-term care setting: Is the multireagent strip an adequate diagnostic tool?
    Arinzon, Zeev
    Peisakh, Alexander
    Shuval, Ishay
    Shabat, Shay
    Berner, Yitshal N.
    [J]. ARCHIVES OF GERONTOLOGY AND GERIATRICS, 2009, 48 (02) : 227 - 231
  • [3] Clinical and Laboratory Standards Institute, 2020, Performance standards for antimicrobial susceptibility testing
  • [4] Clinical and Laboratory Standards Institute, 2005, PERF STAND ANT SUSC
  • [5] D'Agata ED, 2013, J AM GERIATR SOC
  • [6] Variability in Antibiotic Use Across Nursing Homes and the Risk of Antibiotic-Related Adverse Outcomes for Individual Residents
    Daneman, Nick
    Bronskill, Susan E.
    Gruneir, Andrea
    Newman, Alice M.
    Fischer, Hadas D.
    Rochon, Paula A.
    Anderson, Geoffrey M.
    Bell, Chaim M.
    [J]. JAMA INTERNAL MEDICINE, 2015, 175 (08) : 1331 - 1339
  • [7] Prolonged Antibiotic Treatment in Long-term Care Role of the Prescriber
    Daneman, Nick
    Gruneir, Andrea
    Bronskill, Susan E.
    Newman, Alice
    Fischer, Hadas D.
    Rochon, Paula A.
    Anderson, Geoff M.
    Bell, Chaim M.
    [J]. JAMA INTERNAL MEDICINE, 2013, 173 (08) : 673 - 682
  • [8] Extended-spectrum β-lactamase-producing Enterobacteriaceae colonisation in long-term care facilities: a systematic review and meta-analysis
    Flokas, Myrto Eleni
    Alevizakos, Michail
    Shehadeh, Fadi
    Andreatos, Nikolaos
    Mylonakis, Eleftherios
    [J]. INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, 2017, 50 (05) : 649 - 656
  • [9] Isenberg HD, 1998, ESSENTIAL PROCEDURES
  • [10] Juthani-Mehta M, 2009, J AM GERIATR SOC