University of Michigan-Flint, School of Nursing, Flint, MI.
University of Michigan-Flint, School of Nursing, Flint, MI.
Am J Infect Control. 2021 Nov;49(11):1354-1358. doi: 10.1016/j.ajic.2021.04.001. Epub 2021 Apr 16.
Inappropriate antibiotic treatments for urinary tract infection (UTI) in nursing home (NH) residents are common and contribute to antibiotic resistance. Published guidelines aim to improve accurate assessment, diagnosis, and treatment of UTIs. This study assessed whether records from hospitalized NH residents diagnosed with UTI, while comparing the Cooper Tool and Stone criteria, supported appropriate treatment.
A retrospective chart review was conducted using electronic medical record (EMR) data from residents of 3 NHs who were diagnosed with UTI when hospitalized over a 3-year period. The Cooper Tool and Stone criteria were used to assess treatment appropriateness.
Of 79 hospitalized residents treated for UTI, 11 (13.9%) were appropriately treated according to the Cooper Tool and 9 (11.4%) according to Stone. The 2 criteria agreed in 9 of the cases including 100% of those with catheters. Urinalysis was documented in 72% of residents and 24% had documentation of culture and sensitivity.
Appropriate UTI treatment rates using both tools were low but much higher in those with catheters. Future research is necessary to validate the use of these tools in the hospital setting which have the potential to improve treatment accuracy and reduce unnecessary antibiotics use.
在养老院（NH）居民中，尿路感染（UTI）的抗生素治疗不当很常见，这导致了抗生素耐药性的产生。已发布的指南旨在提高 UTI 的准确评估、诊断和治疗水平。本研究评估了在住院 NH 居民中诊断为 UTI 时，住院记录是否支持了根据 Cooper 工具和 Stone 标准进行的适当治疗。
对 3 家 NH 机构的住院居民进行了电子病历（EMR）数据的回顾性图表审查，这些居民在过去 3 年中因 UTI 住院。使用 Cooper 工具和 Stone 标准来评估治疗的适宜性。
在 79 名因 UTI 接受治疗的住院居民中，根据 Cooper 工具，有 11 名（13.9%）的治疗是适当的，根据 Stone 标准，有 9 名（11.4%）的治疗是适当的。这两种标准在 9 例中有相同的结果，其中包括 100%带导管的患者。有 72%的居民记录了尿液分析，24%的居民记录了培养和药敏试验。
使用这两种工具的 UTI 治疗适宜率均较低，但在带导管的患者中则较高。需要进一步的研究来验证这些工具在医院环境中的使用，这有可能提高治疗的准确性并减少不必要的抗生素使用。
