Rotjanapan Porpon, Dosa David, Thomas Kali S
Division of Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City, USA.
Arch Intern Med. 2011 Mar 14;171(5):438-43. doi: 10.1001/archinternmed.2011.13.
The aim of this study was to determine the appropriateness of antibiotic initiation, selection, and duration of therapy among patients in nursing homes with results of a urinalysis showing urinary tract infection.
A retrospective chart review was conducted on patients of 2 nursing homes during a 6-month period (June 1-November 30, 2008). If a urinalysis had been ordered, the case was evaluated for the appropriateness of antibiotic initiation based on the McGeer criteria. For patients receiving antibiotics, the appropriateness of the initial selection, dosing schedule, and duration of treatment were assessed using patient-specific information and Infectious Diseases Society of American criteria. Patients' records were also reviewed for information on the development of Clostridium difficile colitis.
A total of 519 records were reviewed for documentation of a urinalysis; 132 patients, with a total of 172 case patients (ie, urinalysis showing infection) met inclusion criteria. Antibiotic treatment was initiated in 96 of the 172 case patients (56%); 146 case patients (85%) did not meet the McGeer criteria, yet antibiotic treatment was initiated in 70 of these (41%). Furthermore, 69 case patients (72%) received an inappropriate drug based on Infectious Diseases Society of American criteria, 44 case patients (46%) received inappropriate drug dosing based on creatinine clearance, and 64 case patients (67%) received treatment for longer than recommended. Patients who did not meet the McGeer criteria but received antibiotic therapy were 8.5 (95% confidence interval, 1.7-42.2) times more likely to develop C difficile within 3 months of treatment.
Opportunities exist to improve provider practice related to the appropriate treatment of urinary tract infections in the nursing home.
本研究旨在确定疗养院中尿检结果显示患有尿路感染的患者在抗生素起始使用、选择及治疗疗程方面是否恰当。
对两家疗养院的患者进行了为期6个月（2008年6月1日至11月30日）的回顾性病历审查。若已进行尿检，则根据McGeer标准评估抗生素起始使用的恰当性。对于接受抗生素治疗的患者，使用患者特定信息及美国传染病学会标准评估初始选择、给药方案及治疗疗程的恰当性。还审查了患者记录中有关艰难梭菌结肠炎发生情况的信息。
共审查了519份有尿检记录的病历；132名患者，共计172例（即尿检显示感染）符合纳入标准。172例患者中有96例（56%）开始使用抗生素治疗；146例患者（85%）不符合McGeer标准，但其中70例（41%）开始使用了抗生素治疗。此外，根据美国传染病学会标准，69例患者（72%）接受了不恰当的药物治疗，44例患者（46%）根据肌酐清除率接受了不恰当的药物剂量，64例患者（67%）接受的治疗时间超过了推荐时长。未符合McGeer标准但接受抗生素治疗的患者在治疗后3个月内发生艰难梭菌感染的可能性高出8.5倍（95%置信区间，1.7 - 42.2）。
在疗养院中，改善医护人员对尿路感染恰当治疗的做法仍有空间。
