Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes.
Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes.
复制标题
DOI：
10.1186/1471-2318-12-73
复制
发表时间：
2012-11-23
期刊：
影响因子：
4.1
通讯作者：
Garfinkel S
中科院分区：
文献类型：
--
作者：
Phillips CD;Adepoju O;Stone N;Moudouni DK;Nwaiwu O;Zhao H;Frentzel E;Mehr D;Garfinkel S
尿路感染(UTI)是疗养院居民中最常见的治疗感染。即使在没有特定(例如排尿困难)或非特定(例如发烧)迹象或症状的情况下，居民也经常因疑似感染而接受抗生素治疗。这项研究调查了疗养院居民使用抗生素治疗无症状性菌尿(ASB)的相关因素。这是一项横断面研究，对德克萨斯州中部四家疗养院的居民的抗生素处方数据进行了多水平多变量分析。参与者包括这些疗养院的所有居民，他们在六个月的时间里接受了疑似尿路感染的抗生素治疗。我们调查了哪些因素影响了因疑似尿路感染而接受抗生素治疗的居民无症状的可能性。ASB抗生素治疗最有力的预测因素是留置尿管的存在。超过80%的为留置尿管患者开的抗生素处方是为ASB患者开的。对于那些没有导尿管的人，记录审查发现，在151名疑似尿路感染患者中，有204张抗生素处方。其中近50%的处方是为没有UTI症状的居民开的。其中近四分之三的抗生素是在临床医生获得实验室结果后订购的。多变量分析表明，居民特征不影响为ASB开抗生素的可能性。唯一有统计学意义的因素是居民居住的疗养院的身份。我们证实了早期研究的结果，即疗养院经常使用抗生素治疗ASB，特别是对有导尿管的居民。在这个疗养院居民的样本中，没有导管的居民为疑似尿路感染开出的抗生素处方中有一半没有尿路感染的记录体征或症状。对几乎所有疑似尿路感染病例进行了尿液检测，在这些病例中开了抗生素。改善疗养院抗生素管理的努力必须仅根据在没有尿路感染迹象或症状的诊断测试的基础上进行临床决策。
Urinary tract infections (UTIs) are the most commonly treated infection among nursing home residents. Even in the absence of specific (e.g., dysuria) or non-specific (e.g., fever) signs or symptoms, residents frequently receive an antibiotic for a suspected infection. This research investigates factors associated with the use of antibiotics to treat asymptomatic bacteriuria (ASB) among nursing home residents. This was a cross-sectional study involving multi-level multivariate analyses of antibiotic prescription data for residents in four nursing homes in central Texas. Participants included all nursing home residents in these homes who, over a six-month period, received an antibiotic for a suspected UTI. We investigated what factors affected the likelihood that a resident receiving an antibiotic for a suspected UTI was asymptomatic. The most powerful predictor of antibiotic treatment for ASB was the presence of an indwelling urinary catheter. Over 80 percent of antibiotic prescriptions written for catheterized individuals were written for individuals with ASB. For those without a catheter, record reviews identified 204 antibiotic prescriptions among 151 residents treated for a suspected UTI. Almost 50% of these prescriptions were for residents with no documented UTI symptoms. Almost three-quarters of these antibiotics were ordered after laboratory results were available to clinicians. Multivariate analyses indicated that resident characteristics did not affect the likelihood that an antibiotic was prescribed for ASB. The only statistically significant factor was the identity of the nursing home in which a resident resided. We confirm the findings of earlier research indicating frequent use of antibiotics for ASB in nursing homes, especially for residents with urinary catheters. In this sample of nursing home residents, half of the antibiotic prescriptions for a suspected UTI in residents without catheters occurred with no documented signs or symptoms of a UTI. Urine studies were performed in almost all suspected UTI cases in which an antibiotic was prescribed. Efforts to improve antibiotic stewardship in nursing homes must address clinical decision-making solely on the basis of diagnostic testing in the absence of signs or symptoms of a UTI.
登录
查看更多内容
DOI：
10.1016/s1525-8610(04)70213-3
发表时间：
2001-09-01
影响因子：
7.6
作者：
Bentley, D W;Bradley, S;Yoshikawa, T T
通讯作者：
Yoshikawa, T T
影响因子：
3.3
作者：
Mezey, MD;Mitty, EL;Fisher, T
通讯作者：
Fisher, T
DOI：
10.1111/j.1532-5415.2005.53351.x
发表时间：
2005-07-01
影响因子：
6.3
作者：
Mylotte, JM;Keagle, J
通讯作者：
Keagle, J
DOI：
10.1111/j.1532-5415.2005.00470.x
发表时间：
2005-11-01
影响因子：
6.3
作者：
Juthani-Mehta, M;Drickamer, MA;Quagliarello, VJ
通讯作者：
Quagliarello, VJ
影响因子：
6.7
作者：
Burrows, AB;Morris, JN;Phillips, C
通讯作者：
Phillips, C