Potential Inappropriate Treatment of Suspected Urinary Tract Infections Among Nursing Home Residents.

Abstract

Objective: To determine if nurse practitioners and physicians followed recommended practice guidelines prior to the initiation of antibiotics among long-term care (LTC) residents with suspected urinary tract infections (UTIs).

Methods: A retrospective review of 1-year reported cases of UTIs in 2 rural southern nursing homes.

Results: There were 175 cases of UTI reported in the 2 homes, but 6 cases were reported in error. Only 4 of the 169 remaining cases met the diagnostic criteria for UTI. The remaining 169 cases received inappropriate antibiotics. Some of these cases may represent asymptomatic bacteria rather than UTI. Problems were identified with the methods used to collect urine sample that were sent to the laboratory for culture.

Conclusion: We found that in 2 nursing homes, almost all of the reported cases of UTI did not meet the accepted diagnostic criteria. Also, there was inappropriate antibiotic therapy for most of these residents. Nurse practitioners and physicians should accurately determine the presence of UTI and document in the medical record prior to initiating antibiotic. Urine specimens should be collected using appropriate methods. Nursing homes should only report to the Centers for Medicare and Medicaid Services (CMS) those cases that meet the diagnostic criteria as a UTI.