Suspected urinary tract infection (UTI) is the most common type of infection occurring in nursing home residents, and the most common reason for use of antibiotics in the LTC setting. Unfortunately, the majority of antibiotics used for suspecte UTI are inappropriately prescribed. Many suspected nursing home UTI are actually cases of asymptomatic bacteriuria, treatment of which does not improve patient outcomes and may cause harm. In addition to unnecessary drug use, inappropriate treatment may also occur as a result of incorrect antibiotic choice, dose, or duration. While there have been numerous randomized trials to improve suboptimal prescribing in nursing homes, only two specifically targeted treatment of UTI. These studies demonstrated only a modest impact on antibiotic usage and did not target appropriateness of treatment. Consequently, there is a critical need for studies attempting to disseminate effective strategies for the optimal evaluation and treatment of UTI in nursing homes. Our long-term goal is to enhance the health of older nursing home residents with suspected UTI by increasing the appropriateness of antibiotic use through the dissemination of a multifaceted intervention. We will achieve the objectives of this project through two specific aims: 1) evaluate whether the intervention improves antimicrobial prescribing for suspected UTI, and 2) develop and disseminate, in partnership with AMDA, a tool kit based on the protocol used by the intervention group to improve suspected UTI management in control and other nursing homes. In the first aim, we will conduct a cluster randomized controlled trial involving 40 nursing homes in four U.S. geographic regions. Using the Institute of Medicine Patient Safety Model as a guide, we will design and implement a toolkit of communication tools, checklists, and decision support tools targeting various health care providers and nursing home residents/families. Continuous quality improvement methodology, including audit, feedback, and dashboard monitoring, will be applied. The project team will assess the quality and safety of antibiotic prescribing for each suspected UTI and the adverse events monitored. In the second aim, we will revise and disseminate the tool kit, first to control homes, and subsequently, to homes nationally through web and print components as well as media outreach. The methods used to implement and disseminate this project, and the rigorous evaluation of pertinent outcomes, are all innovative aspects of this proposal. The proposed research is significant because it is expected to result in an effective multifaceted intervention that can be exported broadly to improve appropriateness of antibiotic use for UTI, the leading infection in nursing homes. This will, in turn, lessen the risk of adverse drug events, help reduce the growing threat of antimicrobial resistance, and diminish the risk of Clostridium difficile infection.

Public Health Relevance

Suboptimal use of antibiotics for suspected urinary tract infections (UTI) in older nursing home patients can lead to reduced kidney function; the use of multiple medications to treat the UTI; and, ultimately, an injury resulting from use of medication; resistance to antibiotics; and clostridium difficile infections that are difficult to treat and whih can be life-threatening. The infections caused by antibiotic-resistant organisms are associated with increases in hospital transfers, length of hospital stays, deaths, and costs. The proposed project will update the clinical practice guidelines for evaluating and treating suspected UTI; train nursing home staff to address this high-risk, high-priority condition and implement appropriate improvement; and, ultimately, enhance the health of older nursing home residents with suspected UTI by broadly disseminating this multifaceted intervention to other nursing homes throughout the U.S. i

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
Project #
Application #
Study Section
Special Emphasis Panel (HSQR)
Program Officer
Perfetto, Deborah
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University of Pittsburgh
Internal Medicine/Medicine
Schools of Medicine
United States
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