Durkin Michael J, Schmitz Viktoria, Hsueh Kevin, Ney Katheryn, Politi Mary C
Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Open Forum Infect Dis. 2024 Aug 2;11(8):ofae439. doi: 10.1093/ofid/ofae439. eCollection 2024 Aug.
The aim of this study was to elicit clinicians' perspectives to help reduce antibiotic prescribing for asymptomatic bacteriuria and improve a patient-centered educational brochure for older adults with urinary tract infections or asymptomatic bacteriuria.
Between October 2023 and April 2024, we conducted semi-structured qualitative interviews of clinicians who treat patients aged ≥65 years for urinary tract infections or bacteria in the urine, at infectious disease clinics, community senior living facilities, memory care clinics, and general practice. We developed an interview guide based on a behavior change framework and thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques.
We identified several common themes surrounding management of asymptomatic bacteriuria from clinicians. These included an emphasis on ordering and interpreting urine tests, tension between guidelines and individual patient care for older adults, use of epidemiologic data to influence prescribing practices, pre-prepared communication talking points, and interest in educational materials for patients and clinical teams.
Education about the need for symptoms to supplement urine testing, data about the impact of overuse of antibiotics, and oral and written communication strategies should be addressed to reduce antibiotic prescribing for asymptomatic bacteriuria.
本研究的目的是了解临床医生的观点，以帮助减少无症状菌尿的抗生素处方，并改进针对患有尿路感染或无症状菌尿的老年人的以患者为中心的教育手册。
在2023年10月至2024年4月期间，我们对在传染病诊所、社区老年生活设施、记忆护理诊所和全科诊所治疗65岁及以上尿路感染或尿液细菌感染患者的临床医生进行了半结构化定性访谈。我们基于行为改变框架制定了一份访谈指南，并使用归纳和演绎编码技术对录音访谈的书面记录进行了主题分析。
我们从临床医生那里确定了围绕无症状菌尿管理的几个共同主题。这些包括强调尿液检测的开具和解读、老年人指南与个体患者护理之间的紧张关系、利用流行病学数据影响处方实践、预先准备的沟通要点，以及对患者和临床团队教育材料的兴趣。
应开展关于症状对补充尿液检测必要性的教育、抗生素过度使用影响的数据以及口头和书面沟通策略，以减少无症状菌尿的抗生素处方。
