Langford Bradley J, Amoah Stephanie, Hansen Jennifer, Hudd Lorraine, Almohri Huda, Wright Janice
Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, ON, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Infect Control Hosp Epidemiol. 2024 Aug 28;45(10):1-5. doi: 10.1017/ice.2024.93.
Antibiotic overuse for asymptomatic bacteriuria is common in older adults and can lead to harmful outcomes including antimicrobial resistance. Our objective was to evaluate the impact of a simple scoring tool on urine culturing and antibiotic prescribing for adults with presumed urinary tract infections (UTI).
Quasi-experimental study using interrupted time series with segmented regression to evaluate urine culturing and urinary antibiotic use and length of stay (LOS), acute care transfers, and mortality 18 months before and 16 months after the intervention.
134-bed complex continuing care and rehabilitation hospital in Ontario, Canada.
Nurses, nurse practitioners, physicians, and other healthcare professionals.
A multifaceted intervention focusing on a 6-item mnemonic scoring tool called the BLADDER score was developed based on existing minimum criteria for prescribing antibiotics in patients with presumed UTI. The BLADDER score was combined with ward- and prescriber-level feedback and education.
Before the intervention, the mean rate of urine culturing was 12.47 cultures per 1,000 patient days; after the intervention, the rate was 7.92 cultures per 1,000 patient days (IRR 0.87; 95% CI, 0.67-1.12). Urinary antibiotic use declined after the intervention from a mean of 40.55 DDD per 1,000 patient days before and 25.96 DDD per 1,000 patient days after the intervention (IRR 0.68; 95% CI, 0.59-0.79). There was no change in mean patient LOS, acute care transfers, or mortality.
The BLADDER score may be a safe and effective tool to support improved diagnostic and antimicrobial stewardship to reduce unnecessary treatment for asymptomatic bacteriuria.
在老年人中，针对无症状菌尿症过度使用抗生素的情况很常见，且可能导致包括抗菌药物耐药性在内的有害后果。我们的目的是评估一种简单评分工具对疑似尿路感染（UTI）成人患者尿液培养及抗生素处方的影响。
采用中断时间序列和分段回归的准实验研究，以评估干预前18个月及干预后16个月的尿液培养、泌尿系统抗生素使用情况、住院时间（LOS）、急性护理转诊及死亡率。
加拿大安大略省一家拥有134张床位的综合持续护理与康复医院。
护士、执业护士、医生及其他医疗保健专业人员。
基于疑似UTI患者抗生素处方的现有最低标准，开发了一种多方面干预措施，重点是一种名为膀胱（BLADDER）评分的6项助记评分工具。膀胱评分与病房及开处方者层面的反馈和教育相结合。
干预前，尿液培养的平均发生率为每1000患者日12.47次培养；干预后，该发生率为每1000患者日7.92次培养（发病率比[IRR]0.87；95%置信区间[CI]，0.67 - 1.12）。干预后，泌尿系统抗生素使用从干预前每1000患者日平均40.55限定日剂量（DDD）降至每1000患者日25.96 DDD（IRR 0.68；95% CI，0.59 - 0.79）。患者平均住院时间、急性护理转诊或死亡率没有变化。
膀胱评分可能是一种安全有效的工具，有助于改善诊断和抗菌药物管理，以减少对无症状菌尿症的不必要治疗。
