title: Bacteriuria in a geriatric hospital: impact of an antibiotic improvement program.
abstract: 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.
authors.affiliation: Infection Control Unit, Bretonneau Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. christine.bonnal@brt.aphp.fr
authors.forename: Christine
authors.initials: C
authors.lastname: Bonnal
authors.forename: Bruno
authors.initials: B
authors.lastname: Baune
authors.forename: Mathieu
authors.initials: M
authors.lastname: Mion
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefevre
authors.forename: François
authors.initials: F
authors.lastname: L'Heriteau
authors.forename: Yves
authors.initials: Y
authors.lastname: Wolmark
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
mesh_terms: 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