title: Urine Culture Testing in Community Nursing Homes: Gateway to Antibiotic Overprescribing.
abstract: OBJECTIVE To describe current practice around urine testing and identify factors leading to overtreatment of asymptomatic bacteriuria in community nursing homes (NHs) DESIGN Observational study of a stratified random sample of NH patients who had urine cultures ordered in NHs within a 1-month study period SETTING 31 NHs in North Carolina PARTICIPANTS 254 NH residents who had a urine culture ordered within the 1-month study period METHODS We conducted an NH record audit of clinical and laboratory information during the 2 days before and 7 days after a urine culture was ordered. We compared these results with the urine antibiogram from the 31 NHs. RESULTS Empirical treatment was started in 30% of cases. When cultures were reported, previously untreated cases received antibiotics 89% of the time for colony counts of ≥100,000 CFU/mL and in 35% of cases with colony counts of 10,000-99,000 CFU/mL. Due to the high rate of prescribing when culture results returned, 74% of these patients ultimately received a full course of antibiotics. Treated and untreated patients did not significantly differ in temperature, frequency of urinary signs and symptoms, or presence of Loeb criteria for antibiotic initiation. Factors most commonly associated with urine culture ordering were acute mental status changes (32%); change in the urine color, odor, or sediment (17%); and dysuria (15%). CONCLUSIONS Urine cultures play a significant role in antibiotic overprescribing. Antibiotic stewardship efforts in NHs should include reduction in culture ordering for factors not associated with infection-related morbidity as well as more scrutiny of patient condition when results become available. Infect Control Hosp Epidemiol 2017;38:524-531.
authors.affiliation: 1Department of Family Medicine,School of Medicine,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.affiliation: 1Department of Family Medicine,School of Medicine,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kistler
authors.affiliation: 2Cecil G. Sheps Center for Health Services Research,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.affiliation: 3Division of Infectious Diseases,Department of Medicine,School of Medicine,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: 2Cecil G. Sheps Center for Health Services Research,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ward
authors.affiliation: 2Cecil G. Sheps Center for Health Services Research,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001437:Bacteriuria / Q000188:drug therapy / Q000652:urine; D015169:Colony Count, Microbial; D003657:Decision Making; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008485:Medical Audit; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D009657:North Carolina; D009735:Nursing Homes; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology; D014556:Urine / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents