Urinary tract infections (UTI) are a major cause for antibiotic prescribing in frail elderly. The diagnosis of UTI in nursing home and care home residents is often challenging as many cannot clearly express the symptoms, and possible comorbidities make recognition of the symptoms difficult. Therefore, antibiotics to treat UTI in elderly have often been prescribed incorrectly, leading to overprescribing. Unnecessary antibiotic prescribing is harmful for the patients because of the potential side effects and drug interactions. Overprescribing also contributes to the development of antimicrobial resistance.
Antibiotics have been commonly prescribed for patients with non-specific symptoms and asymptomatic bacteriuria. The new guidelines recommend restricting antibiotic prescribing to patients with specific symptoms because non-specific symptoms are often not attributable to UTI, and in asymptomatic bacteriuria, antibiotics are not needed. However, implementation of these new guidelines in practice is challenging as antibiotic prescribing decisions are complex in older adult care settings.
A recent article published in BMJ reported that multifaceted antimicrobial stewardship intervention reduced antibiotic use for UTIs in nursing homes and residential care homes1. A study had more than 1000 elderly participants, and it was conducted in the Netherlands, Poland, Sweden, and Norway. Multifaceted antimicrobial stewardship intervention included a clinical decision-making tool to guide appropriate antibiotic prescribing for UTI in frail older adults according to the clinical guideline recommendations. In addition, the decision-making tool was supported by a toolbox with educational materials targeted at healthcare professionals, caregivers, and patients. The intervention was implemented with a method allowing co-creation with the healthcare providers to adapt the intervention. The development and details of a decision tool are available in an article published earlier2.
The rate ratio for antibiotic prescribing in the intervention group compared to the usual care group was 0.42. The result can be interpreted that per 100 patients, 42 received antibiotics in the intervention group and 100 in the usual care group. According to the authors, the decrease in antibiotic prescribing by intervention tool was substantial, being safe for the patients as there was no difference between the adverse effects or all-cause mortality between the groups.
New and creative Antimicrobial Stewardship interventions are important to enhance the correct use of antibiotics. Proper use of antibiotics will prevent the development of antimicrobial resistance, a major global health threat. Aidian is committed to supporting antimicrobial stewardship actions and healthcare practices that direct sustainable use of antibiotics.
Read the whole article here: https://doi.org/10.1136/bmj-2022-072319
- Hartman EAR et al. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries. BMJ 2023; 380: e072319. https://doi.org/10.1136/bmj-2022-072319
- Van Buul LW et al. The development of a decision tool for the empiric treatment of suspected urinary tract infection in frail older adults: A Delphi Consensus Procedure. JAMDA 2018; 19:757-764. https://doi.org/10.1016/j.jamda.2018.05.001