Optimizing Antibiotic Use in Long Term Care

The purpose of this study was to determine if a multi-faceted intervention to implement diagnostic and therapeutic algorithms for management of suspected urinary infection in nursing home residents could reduce antibiotic prescribing for urinary indications in this population.

Study Overview

• Status: Completed
• Conditions: Urinary Tract Infection, Antibiotic Use
• Intervention / Treatment: Behavioral: diagnostic and treatment clinical algorithms

Detailed Description

Antibiotic use is intense in nursing homes and frequently inappropriate when prescribed for urinary indications. Evidence from randomized controlled trials suggests that treatment of asymptomatic bacteriuria, the presence of bacteria in the urine in the absence of urinary symptoms, is not beneficial. Despite this, one in three prescriptions for urinary indications are for asymptomatic bacteriuria. To improve antibiotic prescribing in this setting we conducted a cluster randomized trial of a strategy to implement diagnostic and treatment algorithms for urinary infection. 24 nursing homes were randomized to either the intervention (implemented at the nursing home level using a multi-faceted approach: small group interactive sessions for nurses, one-on-one interviews for physicians, videotapes, written material, and outreach visits) or to usual care.

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8N 3Z5
      • McMaster University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 second and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Individuals- all residents eligible

2. Nursing homes

   • Free standing long term care facilities with >100 beds
   • No stated policy for diagnosis or treatment of urinary tract infections
   • The facility agrees to refrain from introducing new strategies for antibiotic utilization or clinical pathways during study

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Educational/Counseling/Training
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Antimicrobial prescriptions

Secondary Outcome Measures

Outcome Measure
Urinary cultures,
hospitalizations, deaths

Collaborators and Investigators

• Sponsor: Agency for Healthcare Research and Quality (AHRQ)

Study record dates

Study Major Dates

• Study Start: January 1, 2001
• Study Completion: July 1, 2003

Study Registration Dates

• First Submitted: October 21, 2005
• First Submitted That Met QC Criteria: October 21, 2005
• First Posted (Estimate): October 24, 2005

Study Record Updates

• Last Update Posted (Estimate): October 24, 2005
• Last Update Submitted That Met QC Criteria: October 21, 2005
• Last Verified: October 1, 2005

More Information

Terms related to this study

• Keywords: Urinary tract infections,; antibiotic use,; long term care facilities
• Additional Relevant MeSH Terms: Infections; Urologic Diseases; Urinary Tract Infections
• Other Study ID Numbers: U18HS011113-01 (U.S. AHRQ Grant/Contract)