1. Urinary Tract Infection Guideline Adherence in a Dutch Sentinel Nursing Home Surveillance Network.
- Author
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Yeung GYC, Smalbrugge M, van Buul LW, Rutten JJS, van Houten P, Gerridzen IJ, de Bruijne MC, Joling KJ, and Hertogh CMPM
- Subjects
- Humans, Netherlands, Female, Male, Prospective Studies, Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Sentinel Surveillance, Guideline Adherence, Nursing Homes, Urinary Tract Infections drug therapy, Urinary Tract Infections diagnosis
- Abstract
Objectives: 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., Design: Observational prospective study., Setting and Participants: Nineteen nursing homes participating in a Dutch Sentinel Nursing Home Surveillance Network., Methods: 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., Results: 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., Conclusions and Implications: 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., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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