Methods: This was a retrospective cohort study in six Denver-area nursing homes that evaluated the proportion of proven UTIs per the Revised McGeer Criteria for Long Term Care (Stone, Infect Control Hosp Epidemiol, 2012) versus unproven UTIs, the appropriateness of initial antimicrobial therapy, and the duration of therapy. Participants included NH residents (in post-acute or long term care beds) who received treatment for a UTI between August 2013 and December 2014.
Results: Overall 114 UTI episodes met inclusion criteria. The average age of included patients was 78 years (± 12.2 years) and 70% were female. Nearly twenty-six percent of episodes were proven UTIs based on the Revised McGeer criteria, and 74% were unproven. The mean duration of antimicrobial therapy for these episodes was 7.3 days (± 2.8 days, range 3-17 days), with 28 (27%) episodes treated for more than 7 days. Initial antibiotic therapy with fluoroquinolones (levofloxacin and ciprofloxacin) was common (53.7%), as was initial therapy with trimethoprim-sulfamethoxazole (13%). In 11 cases (13%), the initial drug chosen did not cover the organism. Six of these mismatches were resistant gram negative organisms, 3 were enterococci, and 2 were yeast. Of these 11 episodes, 10 had received a fluorquinolone. There were 3 cases of Clostridium difficile infection diagnosed in patients with qualifying UTI episodes within 6 weeks following the UTI episode (2.6%), one of which occurred following an unproven UTI episode.
Conclusion: Three-quarters of the UTI episodes did not meet Revised McGeer criteria for UTI in LTC. Two-thirds of the UTI episodes were initially treated with antimicrobials to which there are high levels of resistance in NHs, and more than one-quarter received prolonged courses of therapy. Ample opportunities for stewardship may exist in diagnosis and selection of initial therapy for UTI in Denver-area NHs.
C. Drake, None
G. Gahm, None
S. J. Min, None
B. Trautner, None
H. Wald, None