Development, Implementation and Evaluation of Novel Strategies to Reduce Inapprop

描述(由调查人员提供)：由于抗菌素耐药性病原体的推广，在医疗机构中不适当地使用抗菌剂会导致严重的公共健康后果。尿路感染(UTI)在急性护理和长期护理环境中的不适当抗菌药使用中占很大比例，因为它们很常见，而且治疗通常是为无症状菌尿(ASB)开的，没有治疗的指征。此外，许多症状性尿路感染可归因于过度使用导尿管，因此是可以预防的。这项建议的中心假设是，旨在预防和适当管理UTI的基于算法的干预将安全地减少抗菌素的使用，并降低医疗保健系统中的抗菌素耐药率。这项建议的具体目的是：1)。确定三级护理医疗中心及其附属长期护理机构和门诊诊所不适当治疗尿路感染的频率、原因和不良影响；检查ASB不必要的抗菌治疗对耐药病原体的定植和传播的影响，包括耐药革兰氏阴性杆菌、MRSA和耐万古霉素肠球菌；以及3)。确定用于预防和管理尿路感染的基于算法的干预措施，与减少在其他适应症中不必要地使用氟喹诺酮类抗生素的干预措施相结合，是否将安全地减少氟喹诺酮类药物和总抗菌素的使用，并降低医疗体系中的抗菌素耐药率。除尿路感染外，氟喹诺酮类抗生素通常被过度使用于其他综合征。因此，将预防和管理尿路感染的干预措施与减少过度使用氟喹诺酮类药物用于其他适应症的干预措施结合起来，将最大限度地发挥显著降低这些药物施加的选择性压力的潜力。拟议的研究将为医疗机构预防和适当管理尿路感染并减少抗菌素耐药性感染的发展提供一个模式。

DESCRIPTION (provided by investigator): Inappropriate use of antimicrobials in healthcare facilities results in serious public health consequences due to promotion of antimicrobial-resistant pathogens. Urinary tract infections (UTIs) account for a significant proportion of inappropriate antimicrobial use in acute care and long-term care settings because they are common and because treatment is often prescribed for asymptomatic bacteriuria (ASB), for which therapy is not indicated. In addition, many symptomatic UTIs are attributable to overuse of urinary catheters, and are therefore preventable. The central hypothesis of this proposal is that an algorithm-based intervention designed to prevent and appropriately manage UTI will safely decrease antimicrobial use and reduce rates of antimicrobial resistance in a healthcare system. The specific aims of this proposal are to: 1). determine the frequency of, reasons for, and adverse effects of inappropriate treatment of UTI in a tertiary care medical center and affiliated long-term care facilities and outpatient clinics; 2). examine the effect of unnecessary antimicrobial treatment of ASB on colonization and dissemination of antimicrobial-resistant pathogens, including antimicrobial-resistant gram- negative bacilli, MRSA, and vancomycin-resistant Enterococcus; and 3). determine if an algorithm-based intervention for prevention and management of UTI, in combination with an intervention to decrease unnecessary use of fluoroquinolone antibiotics for other indications, will safely decrease fluoroquinolone and total antimicrobial use and reduce rates of antimicrobial resistance in a healthcare system. Fluoroquinolone antibiotics are commonly overused for other syndromes in addition to UTI. Therefore, combining the intervention for prevention and management of UTI with an intervention to decrease overuse of fluoroquinolones for other indications will maximize the potential to significantly reduce selective pressure exerted by these agents. The proposed studies will provide a model for healthcare facilities to prevent and appropriately manage UTIs and to reduce the development of antimicrobial-resistant infections.