Bacteriuria in a geriatric hospital: impact of an antibiotic improvement program.
OBJECTIVE
To prospectively evaluate a management approach to bacteriuria including advice from an infectious diseases consultant (IDC) in geriatric inpatients.


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


METHODS
A 205-bed geriatric university-affiliated hospital.


METHODS
Consecutive hospitalized patients with positive urine cultures.


METHODS
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.


METHODS
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.


CONCLUSIONS
Intervention of an IDC resulted in reduced antimicrobial use in older inpatients with bacteriuria.
Bonnal
Christine
C
Infection Control Unit, Bretonneau Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. christine.bonnal@brt.aphp.fr
Baune
Bruno
B
Mion
Mathieu
M
Armand-Lefevre
Laurence
L
L'Heriteau
François
F
Wolmark
Yves
Y
Lucet
Jean-Christophe
JC
D000368:Aged; D000369:Aged, 80 and over; D001437:Bacteriuria / Q000175:diagnosis / Q000188:drug therapy* / Q000652:urine; D005260:Female; D005851:Geriatric Nursing / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control; D008297:Male; D011446:Prospective Studies; D011704:Pyelonephritis / Q000175:diagnosis / Q000188:drug therapy / Q000652:urine; D011785:Quality Assurance, Health Care; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000652:urine