Clinical experience
Bacteriuria in a Geriatric Hospital: Impact of an Antibiotic Improvement Program

https://doi.org/10.1016/j.jamda.2008.04.004Get rights and content

Objectives

To prospectively evaluate a management approach to bacteriuria including advice from an infectious diseases consultant (IDC) in geriatric inpatients.

Design

Prospective study from July 1, 2003, to June 30, 2004.

Setting

A 205-bed geriatric university-affiliated hospital.

Participants

Consecutive hospitalized patients with positive urine cultures.

Intervention

The hospital's infection control department developed recommendations about antimicrobial use for bacteriuria, which were discussed at staff meetings. Treatments for bacteriuria prescribed by ward physicians were reviewed by an IDC, who suggested changes where appropriate. Physicians were free to follow or to disregard the IDC's suggestions.

Measurements

Patients with positive urine cultures (UC) were classified as having asymptomatic bacteriuria (AB), urinary tract infection (UTI) or pyelonephritis (PN). Prescribed and actual treatments were compared.

Results

Of 252 consecutive positive UCs in 181 patients, 124 (49%) were classified as AB, 88 (35%) as UTI, and 38 (15%) as PN; 2 cases of prostatitis were excluded. The total number of prescribed antimicrobial days before IDC advice was 729 and the actual number (after IDC advice) was 577, for a 152-day (21%) reduction. Most of the reduction was generated by shortening the treatment duration.

Conclusion

Intervention of an IDC resulted in reduced antimicrobial use in older inpatients with bacteriuria.

Section snippets

Study Design

This prospective study was conducted from July 1, 2003, to June 30, 2004, in a geriatric university-affiliated hospital that has 32 acute care beds, 68 intermediate-care beds, and 105 extended-stay beds. Before the beginning of the study, the Infection Control and Antimicrobial Committee of the hospital developed simple recommendations for treating infections. Briefly, these recommendations included the following points, in accordance with recent guidelines: antimicrobials were not recommended

Patients and Urine Cultures

During the 12-month study period, 252 positive urine cultures in 181 patients were included. The sex ratio (F/M) was 4 (145/36) and mean age was 85.0 ± 8.6 years (median, 86; range, 63–102 years). Of the 252 cultures, 49 (19%) occurred in patients with indwelling urinary catheters. In each of 15 cultures, 2 strains were isolated, including 4 yeast strains (not studied here). The 263 bacteria were distributed as follows: Escherichia coli (n = 142, 54%), Klebsiella spp (n = 22, 8%), Pseudomonas

Discussion

UTI is the leading reason for antimicrobial treatment in institutionalized older individuals.1 Thus, well-defined criteria must be used to distinguish AB from UTI requiring antimicrobial therapy. In this study, AB was defined as bacteriuria with no signs or symptoms. It is worth noting that half the bacteriuria cases were classified as ABs, suggesting that urine cultures were frequently obtained in patients who had no symptoms or signs.

Before the intervention of the IDC, 20% of AB cases, 43% of

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The authors have no conflicts of interest pertaining to this article.

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