Postprescriptive Modifications Could Improve Antibiotic Use for UTIs in NHs

Postprescriptive review interventions could substantially improve the quality and practice of antibiotic prescribing for nursing home (NH) residents with suspected urinary tract infections (UTIs). Researchers published their findings in Infection Control & Hospital Epidemiology.

Antibiotics, particularly fluoroquinolones, are frequently used to treat UTIs. Antibiotics have been linked to adverse drug reactions and Clostridioides difficile infections, and fluoroquinolones pose the risk of tendinopathy, confusion, and QT prolongation, researchers said.

“Many of these harmful events are potentially avoidable; it has been estimated that 25%–75% of antibiotic use in nursing homes is inappropriate,” they added.

Health record data from 5 Wisconsin NHs was collected for the cross-sectional study. Antibiotic treatment courses were eligible for the study if the resident was treated for a UTI between 2013 and 2014 and the course was not modified by NH staff in real time.

Researchers analyzed 356 antibiotic treatment courses across 249 NH residents. Of these, only 16.6% of courses showed no opportunity for modification.

For 66.2% of courses, investigators identified the potential for treatment discontinuation due to no signs or symptoms of infection. Potential drug changes were identified in 19% of treatment courses, and 34% of courses could have been shortened.

“If applied in concert at 72 hours after antibiotic initiation, stop and shorten modifications could eradicate up to 1326 avoidable antibiotic days, and change modifications could remove 32 remaining avoidable fluoroquinolone days,” study authors said.

A substantial opportunity exists for using postprescriptive review interventions to improve antibiotic use in NH residents with suspected UTI, although further studies are needed to understand how best to design and implement these modifications, researchers concluded.

Reference:
Langenstroer MC, Jolles S, Hossin T, et al. Antibiotic postprescribing modification opportunities among nursing home residents treated for urinary tract infection. Infect Control Hosp Epidemiol. 2022;1-6. doi:10.1017/ice.2022.202