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Urine Culture Testing in Community Nursing Homes: Gateway to Antibiotic Overprescribing

Published online by Cambridge University Press:  31 January 2017

Philip D. Sloane ,
Christine E. Kistler ,
David Reed ,
David J. Weber ,
Kimberly Ward  and
Sheryl Zimmerman
Philip D. Sloane*
Affiliation:
Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
Christine E. Kistler
Affiliation:
Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
David Reed
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
Kimberly Ward
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
Sheryl Zimmerman
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina School of Social Work, University of North Carolina, Chapel Hill, North Carolina
*
*Address correspondence to Philip D. Sloane, 590 Manning Drive, Chapel Hill, NC 27599 (psloane@med.unc.edu).
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Abstract

OBJECTIVE

To describe current practice around urine testing and identify factors leading to overtreatment of asymptomatic bacteriuria in community nursing homes (NHs)

DESIGN

Observational study of a stratified random sample of NH patients who had urine cultures ordered in NHs within a 1-month study period

SETTING

31 NHs in North Carolina

PARTICIPANTS

254 NH residents who had a urine culture ordered within the 1-month study period

METHODS

We conducted an NH record audit of clinical and laboratory information during the 2 days before and 7 days after a urine culture was ordered. We compared these results with the urine antibiogram from the 31 NHs.

RESULTS

Empirical treatment was started in 30% of cases. When cultures were reported, previously untreated cases received antibiotics 89% of the time for colony counts of ≥100,000 CFU/mL and in 35% of cases with colony counts of 10,000–99,000 CFU/mL. Due to the high rate of prescribing when culture results returned, 74% of these patients ultimately received a full course of antibiotics. Treated and untreated patients did not significantly differ in temperature, frequency of urinary signs and symptoms, or presence of Loeb criteria for antibiotic initiation. Factors most commonly associated with urine culture ordering were acute mental status changes (32%); change in the urine color, odor, or sediment (17%); and dysuria (15%).

CONCLUSIONS

Urine cultures play a significant role in antibiotic overprescribing. Antibiotic stewardship efforts in NHs should include reduction in culture ordering for factors not associated with infection-related morbidity as well as more scrutiny of patient condition when results become available.

Infect Control Hosp Epidemiol 2017;38:524–531

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 5 , May 2017 , pp. 524 - 531
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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