Methods: Three LTCFs (145-470 licensed beds) in Monroe County, New York were recruited. Facility-specific antibiograms and line lists of all urine cultures from the first two quarters of 2014 were obtained from the facilities’ microbiology labs. A sample of records from residents with an ordered urine culture was reviewed. The Loeb criteria was used to evaluate the appropriateness of UTI testing and treatment.
Results: Eight hundred and fifty-five total urine cultures were ordered during the first six months of 2014 at the three facilities which translated into a urine culture rate ranging from 4.2 - 5.5 per 1,000 patient-days. Of the 542 charts available, 123 charts were reviewed. Antibiograms revealed that Escherichia coli was the most common urinary organism with sensitivity to ciprofloxacin varying between 59 - 71% in these facilities. Sixty-one to 84% of residents were inappropriately tested for UTI and 52 – 94% were treated for asymptomatic bacteriuria. Of the 80 residents treated, 56% were treated after culture results were available but few were re-evaluated for the presence of symptoms that triggered the urine culture. Ciprofloxacin was the most common antibiotic used at two of the facilities and cephalosporins at the third LTCF. Nitrofurantoin and trimethoprim/sulfamethoxazole use was uncommon.
Conclusion: Adherence to established guidelines for UTI testing and treatment was poor in the 3 LTCF. Enhanced documentation of urinary symptoms and re-evaluation of residents at the time of urine culture results are recommended to guide treatment decisions. Facility-specific urine culture testing rate, antibiotic use data, antibiograms and assessment of the quality of prescribing are tools that can be used to educate the medical and nursing staff regarding the over-testing and overtreatment of asymptomatic bacteriuria.
C. Felsen, None
E. Dodds Ashley, None
K. K. Trivedi, None
G. Dumyati, None