Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.
Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.
Clin Infect Dis. 2021 Nov 2;73(9):e2763-e2772. doi: 10.1093/cid/ciaa874.
Unnecessary antibiotic treatment of suspected urinary tract infections (UTI) is common in long-term care facilities (LTCFs). However, less is known about the extent of suboptimal treatment, in terms of antibiotic choice, dose, and duration, after the decision to use antibiotics has been made.
We described the frequency of potentially suboptimal treatment among residents with an incident UTI (the first during the study with none in the year prior) in Department of Veterans Affairs (VA) community living centers (CLCs; 2013-2018). Time trends were analyzed using Joinpoint regression. Residents with UTIs receiving potentially suboptimal treatment were compared with those receiving optimal treatment, to identify resident characteristics predictive of suboptimal antibiotic treatment, using multivariable unconditional logistic regression models.
We identified 21 938 residents with an incident UTI treated in 120 VA CLCs, of whom 96.0% were male. Potentially suboptimal antibiotic treatment was identified in 65.0% of residents and decreased 1.8% annually (P < .05). Potentially suboptimal initial drug choice was identified in 45.6% of residents, suboptimal dose frequency in 28.6%, and longer than recommended duration in 12.7%. Predictors of suboptimal antibiotic treatment included prior fluoroquinolone exposure (adjusted odds ratio, 1.38), chronic renal disease (1.19), age ≥85 years (1.17), prior skin infection (1.14), recent high white blood cell count (1.08), and genitourinary disorder (1.08).
Similar to findings in non-VA facilities, potentially suboptimal treatment was common but improving in CLC residents with an incident UTI. Predictors of suboptimal antibiotic treatment should be targeted with antibiotic stewardship interventions to improve UTI treatment.
在长期护理机构（LTCF）中，对疑似尿路感染（UTI）进行不必要的抗生素治疗很常见。然而，在决定使用抗生素后，关于抗生素选择、剂量和疗程方面的治疗不充分的程度，人们了解得较少。
我们描述了退伍军人事务部（VA）社区生活中心（CLC；2013-2018 年）中首次发生 UTI（研究期间无 UTI，前一年无 UTI）的居民中潜在治疗不充分的频率。使用 Joinpoint 回归分析时间趋势。通过多变量无条件逻辑回归模型，比较接受潜在治疗不充分抗生素治疗的居民与接受最佳治疗的居民，以确定预测抗生素治疗不充分的居民特征。
我们确定了 120 个 VA CLC 中 21938 名患有 UTI 的居民，其中 96.0%为男性。65.0%的居民接受了潜在的不充分抗生素治疗，且每年减少 1.8%（P<0.05）。45.6%的居民初始药物选择不充分，28.6%的居民剂量频率不充分，12.7%的患者治疗时间超过推荐时间。抗生素治疗不充分的预测因素包括氟喹诺酮类药物暴露史（调整后比值比，1.38）、慢性肾脏疾病（1.19）、年龄≥85 岁（1.17）、近期皮肤感染（1.14）、近期白细胞计数高（1.08）和泌尿生殖系统疾病（1.08）。
与非 VA 机构的研究结果相似，在发生 UTI 的 CLC 居民中，潜在的治疗不充分仍然很常见，但正在改善。抗生素管理干预措施应针对抗生素治疗不充分的预测因素，以改善 UTI 的治疗。
