1. Urinary Tract Infection Guideline Adherence in a Dutch Sentinel Nursing Home Surveillance Network.
- Author
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Yeung, Gary Y.C., Smalbrugge, Martin, van Buul, Laura W., Rutten, Jeanine J.S., van Houten, Paul, Gerridzen, Ineke J., de Bruijne, Martine C., Joling, Karlijn J., and Hertogh, Cees M.P.M.
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ANTIBIOTICS , *URINARY tract infections , *MEDICAL protocols , *PUBLIC health surveillance , *MEDICAL prescriptions , *SCIENTIFIC observation , *DECISION making in clinical medicine , *NURSING care facilities , *LONGITUDINAL method , *PHYSICIAN practice patterns , *SOCIAL networks , *DRUG prescribing , *OLD age - Abstract
To investigate guideline adherence 3 years after the introduction of a national guideline on urinary tract infections (UTIs) in frail older adults. Appropriate use of urine dipstick tests, treatment decisions, and antibiotic drug choices in residents with (suspected) UTIs without a catheter were examined. Observational prospective study. Nineteen nursing homes participating in a Dutch Sentinel Nursing Home Surveillance Network. As of September 2021, for a 3-month period, medical practitioners recorded additional clinical information in the electronic health record in case of a (suspected) UTI. Based on this information, adherence to guideline recommendations was assessed. Nonadherence was classified into 2 categories: (1) "intentional nonadherence" as reported by practitioners and (2) "nonadherence otherwise" applied to all other cases where the recorded information was discordant with the guideline recommendations. A total of 532 cases of (suspected) UTIs from 469 residents were analyzed. In 455 cases (86%), dipsticks were used. For the 231 cases where clinical signs and symptoms already indicated no UTI treatment according to the guideline, a dipstick was still inappropriately ordered in 196 cases (85%). The decision to prescribe or withhold antibiotics was in 69% of the cases adherent, in 6% intentionally nonadherent, and in 25% nonadherent otherwise. The type of prescribed antibiotic was adherent to the recommended antibiotics for cystitis in 88% and for UTIs with signs of tissue invasion in 48%. Overall, for 40% of suspected UTIs, adherence to all relevant recommendations could be established, and in 9% practitioners reported intentional nonadherence to the guideline. There is considerable room for improvement in all clinical stages of managing a suspected UTI in Dutch nursing homes, particularly with regard to the importance of patient's clinical signs and symptoms for appropriate dipstick use and antibiotic UTI treatments. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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