Antibiotics for the treatment of urinary tract infections (UTIs) are among the most common prescriptions in long-term care facilities (LTCF). However, many LTCFs do not have an antibiotic stewardship program.
A retrospective review was conducted from 1/2014 10/2015 in a 60-bed LTCF in an urban Veteran Affairs (VA) Medical Center. Data collected included organisms isolated in urine cultures, antibiotic susceptibilities, and antibiotic usage (days of therapy (DOT) /1000 patient days). Microbiologic data was reviewed and compared to prescribing data.
During the study period, there were 99 positive urine cultures, from 39 unique patients. In total, 109 organisms were isolated, with Escherichia coli and Proteus mirabilis being the most common (39% and 17% respectively). Among positive urine cultures, 33 (33%) had been started on empiric antibiotics within 48 hours of the culture being obtained. Cefuroxime was prescribed in 55% of those cases. Among organisms cultured 21 of 35 (60%) were resistant to the prescribed empiric antibiotic.
Prescribing patterns, during 2014 2015, revealed an increase in cefuroxime use (11 in 2014 to 28 in 2015 DOT / 1000 patient days; p < 0.00001) and amoxicillin/clavulanate (6 to 13 DOT / 1000 patient days; p < 0.00001). Sulfamethoxazole / trimethoprim use decreased (8 to 5 DOT / 1000 patient days; p = 0.002). There was minimal use of nitrofurantoin (Figure 1).
Susceptibility for cefazolin decreased (48% in 2014 to 22% in 2015) as did cefuroxime (54% to 45%). Increasing susceptibility was noted for ciprofloxacin (41% to 64%) and nitrofurantoin (34% to 57%). There was minimal change in susceptibilities for sulfamethoxazole / trimethoprim (59% to 64%) and amoxicillin/clavulanate (49% to 52%). The changes in quarterly susceptibility were significant for cefazolin and nitrofurantoin (p for trends = 0.014 and 0.0072 respectively). At the end of the study period, oral beta-lactams had lower susceptibility rates than did other classes (Figure 2).
There was an association between antimicrobial use and resistance rates of urinary pathogens, during the study period. Susceptibility data and prescribing practices should be routinely assessed in LTCF settings, and should impact treatment guidelines.
L. R. Chigurupati, None
B. Siepierski, None
K. S. Kaye, None
S. Dhar, None