McMaughan Darcy K, Nwaiwu Obioma, Zhao Hongwei, Frentzel Elizabeth, Mehr David, Imanpour Sara, Garfinkel Steven, Phillips Charles D
Texas A&M University, College Station, USA.
Department of Health Policy & Management, School of Public Health, 1266 TAMU, College Station, TX, 77843, USA.
BMC Geriatr. 2016 Apr 15;16:81. doi: 10.1186/s12877-016-0255-9.
Antibiotics are highly utilized in nursing homes. The aim of the study was to test the effectiveness of a decision-making aid for urinary tract infection management on reducing antibiotic prescriptions for suspected bacteriuria in the urine without symptoms, known as asymptomatic bacteriuria (ASB) in twelve nursing homes in Texas.
A pre- and post-test with comparison group design was used. The data was collected through retrospective chart review. The study sample included 669 antibiotic prescriptions for suspected urinary tract infections ordered for 547 nursing home residents. The main measurement for the outcome variable was whether an antibiotic was prescribed for suspected urinary tract infections with no symptoms present.
Most of the prescriptions for antibiotics UTIs were written without documented symptoms - thus for asymptomatic bacteuria (ASB) (71 % during the pre-intervention period). Exposure to the decision-making aid decreased the number of prescriptions written for ASB (from 78 % to 65 % in the low-intensity homes and from 65 % to 57 % in the high-intensity homes), and decreased odds of a prescription being written for ASB (OR = 0.63, 95 % CI = 0.25 - 1.60 for low-intensity homes; OR = 0.79, 95 % CI = 0.33 - 1.88 for high-intensity homes). The odds of a prescription being written for ASB decreased significantly in homes that succeeded in implementing the decision-making aid (OR = 0.35, 95 % CI = 0.16-0.76), compared to homes with no fidelity.
The decision-making aid improved antibiotic stewardship in nursing homes.
抗生素在疗养院中被大量使用。本研究的目的是测试一种用于尿路感染管理的决策辅助工具在德克萨斯州的12家疗养院中减少对无症状菌尿（ASB）（即尿液中疑似菌尿但无临床症状）使用抗生素处方的有效性。
采用前后测及对照组设计。数据通过回顾性病历审查收集。研究样本包括为547名疗养院居民开出的669份疑似尿路感染的抗生素处方。结果变量的主要衡量指标是是否为无临床症状的疑似尿路感染开具抗生素。
大多数尿路感染抗生素处方开具时并无症状记录——因此是针对无症状菌尿（ASB）（干预前期为71%）。使用决策辅助工具后，ASB的处方数量减少（低强度疗养院从78%降至65%，高强度疗养院从65%降至57%），且开具ASB处方的几率降低（低强度疗养院：OR = 0.63，95% CI = 0.25 - 1.60；高强度疗养院：OR = 0.79，95% CI = 0.33 - 1.88）。与未严格执行的疗养院相比，成功实施决策辅助工具的疗养院开具ASB处方的几率显著降低（OR = 0.35，95% CI = 0.16 - 0.76）。
该决策辅助工具改善了疗养院的抗生素管理。
