Clinical Uncertainties in the Approach to Long Term Care Residents With Possible Urinary Tract Infection

Journal of the American Medical Directors Association

Volumn 15, Issue 2, 2014, Pages 133-139

  Nace, David A ^a   Drinka, Paul J ^b,c   Crnich, Christopher J ^b,d  

^a UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH   (United States)

^c MEDICAL COLLEGE OF WISCONSIN   (United States)

^d WILLIAM S MIDDLETON MEMORIAL VETERANS HOSPITAL   (United States)

Author keywords

Antimicrobial stewardship; Medical decision making; Nursing home; Urinary tract infection (UTI)

Indexed keywords

ANTIBIOTIC AGENT;

ANTIBIOTIC RESISTANCE; ANTIBIOTIC THERAPY; ARTICLE; COGNITIVE DEFECT; DELIRIUM; FATIGUE; FEVER; HUMAN; INFECTION CONTROL; LONG TERM CARE; NURSING HOME; NURSING HOME PERSONNEL; PATIENT SAFETY; PROSTATE DISEASE; QUALITY CONTROL; RANDOMIZED CONTROLLED TRIAL (TOPIC); RESIDENT; SWELLING; TREATMENT FAILURE; URINALYSIS; URINARY CATHETER; URINARY TRACT INFECTION; URINE CULTURE;

ANTIMICROBIAL STEWARDSHIP; MEDICAL DECISION MAKING; NURSING HOME; URINARY TRACT INFECTION (UTI);

ANTI-BACTERIAL AGENTS; ASYMPTOMATIC DISEASES; BACTERIURIA; DECISION MAKING; HUMANS; INAPPROPRIATE PRESCRIBING; INFECTION CONTROL; LONG-TERM CARE; NURSING HOMES; PHYSICIAN EXECUTIVES; PHYSICIAN'S ROLE; URINARY TRACT INFECTIONS; WATCHFUL WAITING;

EID: 84892953688     PISSN: 15258610     EISSN: 15389375     Source Type: Journal    
DOI: 10.1016/j.jamda.2013.11.009     Document Type: Article

References (82)

1. Snustad D. Response to "Clinical practice guideline for the evaluation of fever and infection in older adult residents of long term care facilities: 2008 update by the Infectious Diseases Society of America.". J Am Geriatr Soc 2009, 57:2157-2158.
2. Balogun S., Philbrick J.T. Delirium, a symptom of UTI in the elderly: Fact or fableα A systematic review. J Am Med Dir Assoc 2013, 14:B21.
3. Drinka P. Does urinary tract infection cause residents' mental status changeα. J Am Geriatr Soc 2009, 57:2387-2388.
4. High K.P., Bradley S.F., Gravenstein S., et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 2009, 48:149-171.
5. Walker S., McGeer A., Simor A.E., et al. Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly peopleα A qualitative study of physicians' and nurses' perceptions. CMAJ 2000, 163:273-277.
6. High K.P., Yoshikawa T.T. Reply to Dr Snustad. J Am Geriatr Soc 2009, 57:2158-2159.
7. Gau J.T., Clay S. Diagnostic accuracy of criteria for urinary tract infection in nursing homes. J Am Geriatr Soc 2008, 56:571.
8. Loeb M., Bentley D.W., Bradley S., et al. Development of minimum criteria for the initiation of antibiotics in residents of long term care facilities: Results of a consensus conference. Infect Control Hosp Epidemiol 2001, 22:120-124.
9. Loeb M., Brazil K., Lohfeld L., et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: Cluster randomised controlled trial. BMJ 2005, 331:669.
10. McGeer A., Campbell B., Emori T.G., et al. Definitions of infection for surveillance in long term care facilities. Am J Infect Control 1991, 19:1-7.
11. Stone N.D., Ashraf M.S., Calder J., et al. Surveillance definitions of infections in long term care facilities: Revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012, 33:965-977.
12. Juthani-Mehta M., Drickamer M.A., Towle V., et al. Nursing home practitioner survey of diagnostic criteria for urinary tract infections. J Am Geriatr Soc 2005, 53:1986-1990.
13. Juthani-Mehta M., Quagliarello V., Perrelli E., et al. Clinical features to identify urinary tract infection in nursing home residents: A cohort study. J Am Geriatr Soc 2009, 57:963-970.
14. D'Agata E., Loeb M.B., Mitchell S.L. Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. J Am Geriatr Soc 2013, 61:62-66.
15. Phillips C.D., Adepoju O., Stone N., et al. Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes. BMC Geriatr 2012, 12:73.
16. Resnick N.M., Marcantonio E.R. How should clinical care of the aged differα. Lancet 1997, 350:1157-1158.
17. Infection Management for Geriatrics in Long Term Care Facilities 2007, Informa Healthcare, New York. 2nd ed. T.T. Yoshikawa, J.G. Ouslander (Eds.).
18. Sundvall P.D., Ulleryd P., Gunnarsson R.K. Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: A cross-sectional study of 32 nursing homes. BMC Fam Pract 2011, 12:36.
19. Orr P.H., Nicolle L.E., Duckworth H., et al. Febrile urinary infection in the institutionalized elderly. Am J Med 1996, 100:71-77.
20. Boscia J.A., Kobasa W.D., Abrutyn E., et al. Lack of association between bacteriuria and symptoms in the elderly. Am J Med 1986, 81:979-982.
21. Das R., Towle V., Van Ness P.H., Juthani-Mehta M. Adverse outcomes in nursing home residents with increased episodes of observed bacteriuria. Infect Control Hosp Epidemiol 2011, 32:84-86.
22. Juthani-Mehta M., Tinetti M., Perrelli E., et al. Interobserver variability in the assessment of clinical criteria for suspected urinary tract infection in nursing home residents. Infect Control Hosp Epidemiol 2008, 29:446-449.
23. Barkham T.M., Martin F.C., Eykyn S.J. Delay in the diagnosis of bacteraemic urinary tract infection in elderly patients. Age Ageing 1996, 25:130-132.
24. Woodford H.J., Graham C., Meda M., Miciuleviciene J. Bacteremic urinary tract infection in hospitalized older patients-are any currently available diagnostic criteria sensitive enoughα. J Am Geriatr Soc 2011, 59:567-568.
25. Rotjanapan P., Dosa D., Thomas K.S. Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes. Arch Intern Med 2011, 171:438-443.
26. Levy C.R., Eilertsen T., Kramer A.M., Hutt E. Which clinical indicators and resident characteristics are associated with health care practitioner nursing home visits or hospital transfer for urinary tract infectionsα. J Am Med Dir Assoc 2006, 7:493-498.
27. Richards C.L., Darradji M., Weinberg A., Ouslander J.G. Antimicrobial use in post-acute care: A retrospective descriptive analysis in seven long term care facilities in Georgia. J Am Med Dir Assoc 2005, 6:109-112.
28. Pettersson E., Vernby A., Molstad S., Lundborg C.S. Infections and antibiotic prescribing in Swedish nursing homes: A cross-sectional study. Scand J Infect Dis 2008, 40:393-398.
29. Lohfeld L., Loeb M., Brazil K. Evidence-based clinical pathways to manage urinary tract infections in long term care facilities: A qualitative case study describing administrator and nursing staff views. J Am Med Dir Assoc 2007, 8:477-484.
30. Loeb M., Brazil K., Lohfeld L., et al. Optimizing antibiotics in residents of nursing homes: Protocol of a randomized trial. BMC Health Serv Res 2002, 2:17.
31. Zabarsky T.F., Sethi A.K., Donskey C.J. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long term care facility through an educational intervention. Am J Infect Control 2008, 36:476-480.
32. Federal Register. 2011. Available at. Accessed August 9, 2013. http://www.gpo.gov/fdsys/pkg/FR-2011-01-26/html/2011-1540.htm.
33. Federal Register. 2010. Available at. Accessed August 9, 2013. http://www.gpo.gov/fdsys/pkg/FR-2010-07-01/html/2010-15796.htm.
34. Frentzel E, Moudouni D, Garfinkel S, et al. Standardizing antibiotic use in long term care settings (SAUL Study): Final report. August 15, 2012. American Institutes for Research, Texas A&M University School of Rural Public Health, TMF Health Quality Institute; 2012.
35. Olsho L.E., Bertrand R.M., Edwards A.S., et al. Does adherence to the Loeb minimum criteria reduce antibiotic prescribing rates in nursing homesα. J Am Med Dir Assoc 2013, 14:309.e1-309.e7.
36. Standardizing Antibiotic Use in Long Term Care Settings (SAUL Study): Final Report October 17, 2012. Abt Associates Inc, University of North Carolina; 2012.
37. Benoit S.R., Nsa W., Richards C.L., et al. Factors associated with antimicrobial use in nursing homes: A multilevel model. J Am Geriatr Soc 2008, 56:2039-2044.
38. Blix H.S., Bergman J., Schjott J. How are antibacterials used in nursing homesα Results from a point-prevalence prescription study in 44 Norwegian nursing homes. Pharmacoepidem Dr S 2010, 19:1025-1030.
39. Loeb M., Simor A.E., Landry L., et al. Antibiotic use in Ontario facilities that provide chronic care. J Gen Intern Med 2001, 16:376-383.
40. Nicolle L.E. Urinary tract infections in long term care facilities. Infect Control Hosp Epidemiol 1993, 14:220-225.
41. Nicolle L.E. Urinary tract infection in long term care facility residents. Clin Infect Dis 2000, 31:757-761.
42. Yoshikawa T.T., Nicolle L.E., Norman D.C. Management of complicated urinary tract infection in older patients. J Am Geriatr Soc 1996, 44:1235-1241.
43. Mou T.W., Siroty R., Ventry P. Bacteriuria in elderly, chronically ill patients. J Am Geriatr Soc 1962, 10:170-178.
44. Abrutyn E., Mossey J., Levison M., et al. Epidemiology of asymptomatic bacteriuria in elderly women. J Am Geriatr Soc 1991, 39:388-393.
45. Abrutyn E., Mossey J., Berlin J.A., et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory womenα. Ann Intern Med 1994, 120:827-833.
46. Nicolle L.E., Bjornson J., Harding G.K., MacDonell J.A. Bacteriuria in elderly institutionalized men. N Engl J Med 1983, 309:1420-1425.
47. Nicolle L.E., Mayhew W.J., Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med 1987, 83:27-33.
48. Ouslander J.G., Schapira M., Schnelle J.F., et al. Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residentsα. Ann Intern Med 1995, 122:749-754.
49. Juthani-Mehta M., Tinetti M., Perrelli E., et al. Role of dipstick testing in the evaluation of urinary tract infection in nursing home residents. Infect Control Hosp Epidemiol 2007, 28:889-891.
50. Sundvall P.D., Gunnarsson R.K. Evaluation of dipstick analysis among elderly residents to detect bacteriuria: A cross-sectional study in 32 nursing homes. BMC Geriatr 2009, 9:32.
51. Wagenlehner F.M., Naber K.G., Weidner W. Asymptomatic bacteriuria in elderly patients: Significance and implications for treatment. Drugs Aging 2005, 22:801-807.
52. Ducharme J., Neilson S., Ginn J.L. Can urine cultures and reagent test strips be used to diagnose urinary tract infection in elderly emergency department patients without focal urinary symptomsα. CJEM 2007, 9:87-92.
53. Crossley K., Henry K., Irvine P., Willenbring K. Antibiotic use in nursing homes: Prevalence, cost and utilization review. Bull N Y Acad Med 1987, 63:510-518.
54. Field T.S., Gurwitz J.H., Avorn J., et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 2001, 161:1629-1634.
55. Takahashi P., Trang N., Chutka D., Evans J. Antibiotic prescribing and outcomes following treatment of symptomatic urinary tract infections in older women. J Am Med Dir Assoc 2004, 5:S11-S15.
56. Bradley S.F., Terpenning M.S., Ramsey M.A., et al. Methicillin-resistant Staphylococcus aureus: Colonization and infection in a long term care facility. Ann Intern Med 1991, 115:417-422.
57. Braykov N.P., Eber M.R., Klein E.Y., et al. Trends in resistance to carbapenems and third-generation cephalosporins among clinical isolates of Klebsiella pneumoniae in the United States, 1999-2010. Infect Control Hosp Epidemiol 2013, 34:259-268.
58. Crnich C.J., Duster M., Hess T., et al. Antibiotic resistance in non-major metropolitan skilled nursing facilities: Prevalence and interfacility variation. Infect Control Hosp Epidemiol 2012, 33:1172-1174.
59. Furuno J.P., Shurland S.M., Zhan M., et al. Comparison of the methicillin-resistant Staphylococcus aureus acquisition among rehabilitation and nursing home residents. Infect Control Hosp Epidemiol 2011, 32:244-249.
60. Maslow J.N., Lee B., Lautenbach E. Fluoroquinolone-resistant Escherichia coli carriage in long term care facility. Emerg Infect Dis 2005, 11:889-894.
61. Mody L., Kauffman C.A., Donabedian S., et al. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008, 46:1368-1373.
62. Muder R.R., Brennen C., Wagener M.M., et al. Methicillin-resistant staphylococcal colonization and infection in a long term care facility. Ann Intern Med 1991, 114:107-112.
63. Stone N.D., Lewis D.R., Lowery H.K., et al. Importance of bacterial burden among methicillin-resistant Staphylococcus aureus carriers in a long term care facility. Infect Control Hosp Epidemiol 2008, 29:143-148.
64. van Buul L.W., van der Steen J.T., Veenhuizen R.B., et al. Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc 2012, 13:568.e1-568.e13.
65. Viray M., Linkin D., Maslow J.N., et al. Longitudinal trends in antimicrobial susceptibilities across long term care facilities: Emergence of fluoroquinolone resistance. Infect Control Hosp Epidemiol 2005, 26:56-62.
66. Strausbaugh L.J., Crossley K.B., Nurse B.A., Thrupp L.D. Antimicrobial resistance in long term care facilities. Infect Control Hosp Epidemiol 1996, 17:129-140.
67. Crnich C.J., Safdar N., Robinson J., Zimmerman D. Longitudinal trends in antibiotic resistance in US nursing homes, 2000-2004. Infect Control Hosp Epidemiol 2007, 28:1006-1008.
68. Bonomo R.A. Multiple antibiotic-resistant bacteria in long term care facilities: An emerging problem in the practice of infectious diseases. Clin Infect Dis 2000, 31:1414-1422.
69. Loeb M.B., Craven S., McGeer A.J., et al. Risk factors for resistance to antimicrobial agents among nursing home residents. Am J Epidemiol 2003, 157:40-47.
70. Das R., Perrelli E., Towle V., et al. Antimicrobial susceptibility of bacteria isolated from urine samples obtained from nursing home residents. Infect Control Hosp Epidemiol 2009, 30:1116-1119.
71. Swaminathan M., Sharma S., Poliansky Blash S., et al. Prevalence and risk factors for acquisition of carbapenem-resistant enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013, 34:809-817.
72. Lee B.Y., Song Y., Bartsch S.M., et al. Long term care facilities: Important participants of the acute care facility social networkα. PLoS One 2011, 6:e29342.
73. Won S.Y., Munoz-Price L.S., Lolans K., et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011, 53:532-540.
74. Drinka P.J., Crnich C.J., Nace D.A. An antibiotic prescription induces resistance at the individual level more than the group level. J Am Med Dir Assoc 2013, 14:707-708.
75. Choosing Wisely, An Initiative of the ABIM Foundation: Five Things Physicians and Patients Should Question. 2013. Available at. Accessed October 29, 2013. http://www.amda.com/tools/choosingwisely.cfm.
76. Choosing Wisely, An Initiative of the ABIM Foundation: Five Things Physicians and Patients Should Question. 2013. Available at. Accessed August 9, 2013. mailto:http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/choosingwisely.
77. Pettersson E., Vernby A., Molstad S., Lundborg C.S. Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residentsα A cluster randomized controlled trial. J Antimicrob Chemother 2011, 66:2659-2666.
78. Carusone S.C., Loeb M., Lohfeld L. Pneumonia care and the nursing home: A qualitative descriptive study of resident and family member perspectives. BMC Geriatr 2006, 6:2.
79. State Operations Manual, Appendix PP. Available at. Accessed October 29, 2013. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf.
80. Nursing Home Compare. Available at. Accessed October 29, 2013. http://www.medicare.gov/nursinghomecompare/.
81. QAPI At A Glance: A Step by Step Guide to Implementing Quality Assurance and Performance Improvement (QAPI) in Your Nursing Home. 2013. Available at. Accessed October 29, 2013. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/Downloads/QAPIAtaGlance.pdf.
82. Smith K.M., Castle N.G., Hyer K. Implementation of quality assurance and performance improvement programs in nursing homes: A brief report. J Am Med Dir Assoc 2013, 14:60-61.