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Grant A, Cohen Z, Cooper KL. Management of Asymptomatic Bacteriuria in Non-Catheterized Adults. Urol Clin North Am 2024; 51:561-570. [PMID: 39349023 DOI: 10.1016/j.ucl.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Understanding the management of asymptomatic bacteriuria (ASB) is important given the prevalence of the condition, associated risks in certain patient populations, and the risks associated with inappropriate antibiotic administration. Generally, screening and treatment is only recommended in pregnant women and in those undergoing urologic procedures that will violate the urothelium. Knowing the appropriate time to screen and treat ASB is critical for managing high-risk patients and preventing the growth of antibiotic resistance. Recent research into the protective nature of avirulent strains of Escherichia coli might offer a new approach to management of ASB.
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Affiliation(s)
- Allison Grant
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA.
| | - Zoë Cohen
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
| | - Kimberly L Cooper
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA
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2
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Palat SIT, Biehle L, Adler L. Rapid Molecular Testing for UTIs: A Diagnostic Stewardship Perspective. J Am Med Dir Assoc 2024; 25:105031. [PMID: 38772527 DOI: 10.1016/j.jamda.2024.105031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/23/2024]
Abstract
With increased focus on antimicrobial stewardship in post-acute, long-term care (PALTC) settings, optimization of diagnostic testing is essential. Molecular diagnostics are currently being offered and used for the diagnosis of urinary tract infections (UTIs) in community and PALTC settings. Yet, no studies to date explore the role of rapid diagnostics such as polymerase chain reaction and other molecular methods in the stewardship efforts of PALTC settings, specifically compared with standard testing with urinalysis and culture with antimicrobial susceptibility testing. This article outlines a framework of diagnostic stewardship to critically evaluate the use of molecular diagnostics for the diagnosis of UTIs in PALTC and the impact on patient outcomes and antimicrobial stewardship. The authors suggest a 5-step process for evaluating the role of novel diagnostics in the PALTC setting. Understanding the shortcomings of newer diagnostic tests may identify needs for further investigation before their widespread use.
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Affiliation(s)
| | - Lauren Biehle
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Laurent Adler
- Home and Community Care, Optum, Eden Prairie, MN, USA
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3
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Llor C, Moragas A, Ruppe G, Lykkegaard J, Hansen MP, Antsupova VS, Jensen JN, Theut AM, Petek D, Sodja N, Kowalczyk A, Bjerrum L. Diagnosing probable urinary tract infections in nursing home residents without indwelling catheters: a narrative review. Clin Microbiol Infect 2024:S1198-743X(24)00419-1. [PMID: 39209268 DOI: 10.1016/j.cmi.2024.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/18/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Overdiagnosis of urinary tract infections (UTIs) is one of the most common reasons for the unnecessary use of antibiotics in nursing homes, increasing the risk of missing serious conditions. Various decision tools and algorithms aim to aid in UTI diagnosis and the initiation of antibiotic therapy for residents. However, due to the lack of a clear reference standard, these tools vary widely and can be complex, with some requiring urine testing. As part of the European-funded IMAGINE project, aimed at improving antibiotic use for UTIs in nursing home residents, we have reviewed the recommendations. OBJECTIVES This review provides a comprehensive summary of the more relevant tools and algorithms aimed at identifying true UTIs among residents living in nursing homes and discusses the challenges in using these algorithms based on updated research. SOURCES The discussion is based on a relevant medical literature search and synthesis of the findings and published tools to provide an overview of the current state of improving the diagnosis of UTIs in nursing homes. CONTENT The following topics are covered: prevalence of asymptomatic bacteriuria, diagnostic challenges, clinical criteria, urinary testing, and algorithms to be implemented in nursing home facilities. IMPLICATIONS Diagnosing UTIs in residents is challenging due to the high prevalence of asymptomatic bacteriuria and nonspecific urinary tract signs and symptoms among those with suspected UTIs. The fear of missing a UTI and the perceived antibiotic demands from residents and relatives might lead to overdiagnosis of this common condition. Despite their widespread use, urine dipsticks should not be recommended for geriatric patients. Patients who do not meet the minimum diagnostic criteria for UTIs should be evaluated for alternative conditions. Adherence to a simple algorithm can prevent unnecessary antibiotic courses without compromising resident safety.
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Affiliation(s)
- Carl Llor
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark; Primary Care Research Institute Jordi Gol, Institut d'Investigació en Atenció Primària (IDIAP), Barcelona, Spain; CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Ana Moragas
- Primary Care Research Institute Jordi Gol, Institut d'Investigació en Atenció Primària (IDIAP), Barcelona, Spain; CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of General Pathology. University Rovira i Virgili, Tarragona, Spain
| | - Georg Ruppe
- Austrian Interdisciplinary Platform on Ageing/Österreichische Plattform für Interdisziplinäre Alternsfragen (OEPIA), Vienna, Austria
| | - Jesper Lykkegaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Malene Plejdrup Hansen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark; Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Valeria S Antsupova
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Jette Nygaard Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Anna Marie Theut
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Davorina Petek
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Sodja
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Anna Kowalczyk
- Centre for Family and Community Medicine, the Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland
| | - Lars Bjerrum
- Department of Public Health, Section and Research Unit of General Practice, University of Copenhagen, Copenhagen, Denmark
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Hunold KM, Mion LC, Gure TR, Schwaderer AL, Exline M, Hebert C, Lampert BC, Southerland LT, Stephens JA, Boyer EW, Hill M, Chu CMB, Reider C, Caterino JM. Clinical performance of existing diagnostic criteria for pneumonia in older emergency patients: A prospective cohort study. J Am Geriatr Soc 2024. [PMID: 39180291 DOI: 10.1111/jgs.19113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/20/2024] [Accepted: 06/30/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Pneumonia accounts for over half a million older adult emergency department (ED) visits annually, but ED pneumonia diagnosis is inaccurate. Geriatric-specific pneumonia diagnostic criteria exist for other settings; no prospective data exist to determine if application in the older adult ED population is feasible. The objective was to prospectively evaluate the utility of four current diagnostic criteria (Loeb; Modified McGeer; Infectious Disease Society of America/American Thoracic Society; American College of Emergency Physicians) in older adult ED patients. METHODS This was a prospective, observational cohort study of older adult ED patients ≥65 years of age in two U.S. EDs with suspected pneumonia defined as having chest radiography ordered and treating physician suspicion. The standard we used for defining the presence, absence, or inability to determine a diagnosis of pneumonia diagnosis was expert physician chart adjudication. We report the summary statistics for demographic characteristics and symptoms/exam findings and sensitivity, specificity, and likelihood ratios with 95% confidence intervals of the existing diagnostic criteria. Pre-specified cutoff values of a positive LR >10 and a negative LR <0.3 were considered clinically significant. RESULTS Of 135 patients enrolled, 27 had pneumonia by adjudicator review. Typical patient-reported pneumonia symptoms, such as fever (18.5%) and new/worse cough (51.9%), were not consistently present in pneumonia. The IDSA/ATS and ACEP criteria had positive LR >10 and negative LR <0.3; however, all confidence intervals included pre-specified cutoffs. CONCLUSIONS Older adults presented to the ED with low frequency of typical pneumonia symptoms. Although existing diagnostic definitions had promising test characteristics, they may not perform well enough for clinical application without refinement.
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Affiliation(s)
- Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lorraine C Mion
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Tanya R Gure
- Division of General Internal Medicine & Geriatrics, The Ohio State University, Columbus, Ohio, USA
| | - Andrew L Schwaderer
- Section of Pediatric Nephrology, Indiana University, Indianapolis, Indiana, USA
| | - Matthew Exline
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
- Division of Infectious Disease, The Ohio State University, Columbus, Ohio, USA
| | - Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Julie A Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Edward W Boyer
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Hill
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ching-Min B Chu
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Carson Reider
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
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Li J, Yin X, Zhao Y, Yang X, Wang J, Yuan T, Zheng J, Tang Q, Wei W. Fluoroquinolones-related psychiatric adverse events: a real‑world retrospective and pharmacovigilance database analysis. Expert Opin Drug Saf 2024:1-14. [PMID: 39082071 DOI: 10.1080/14740338.2024.2387313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/27/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The purpose of this study was to evaluate the pharmacovigilance and clinical characteristics of psychiatric adverse events(AEs) related to Fluoroquinolones(FQs), and to determine the risk factors for timely management. METHODS Data about AE reporting comes from the FDA Adverse Event Reporting System (FAERS) database, which was used for pharmacovigilance assessments. In addition, we also analyzed the cases of psychiatric AEs related to FQs retrospectively. RESULTS Both of the FAERS database analysis and literature reports show that the proportion of FQs-related psychiatric AEs reported in females were higher (51.11% VS 33.44% and 53.23% VS 46.77%). Both of them show that the proportion of psychiatric AEs caused by FQs was higher in the age groups of 19-44 (28.08% and 40.32%) and 45-64 (28.17% and 25.81%). Most psychiatric AEs occurred within 10 days after FQs administration. Literature shows that 67.74% of the psychiatric AEs disappeared within 3 days after drug withdrawal (some cases were accompanied by other drug). CONCLUSION Psychiatric AEs caused by FQs are serious, and there are many important safety signals that have not been mentioned in the label or previous studies. It is very important to identify and manage psychiatric AEs in time for the safe use of FQs.
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Affiliation(s)
- JuanJuan Li
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, China
| | - Xiaohong Yin
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, China
| | - Yang Zhao
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, China
| | - Xueqin Yang
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, China
| | - Jing Wang
- Department of Pharmacy, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Ting Yuan
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, China
| | - Juan Zheng
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, China
| | - Qian Tang
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, China
| | - Wei Wei
- Department of Pharmacy, People's Hospital of Zhongjiang County, Deyang, China
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Bilsen MP, Conroy SP, Schneeberger C, Platteel TN, van Nieuwkoop C, Mody L, Caterino JM, Geerlings SE, Köves B, Wagenlehner F, Kunneman M, Visser LG, Lambregts MMC. A reference standard for urinary tract infection research: a multidisciplinary Delphi consensus study. THE LANCET. INFECTIOUS DISEASES 2024; 24:e513-e521. [PMID: 38458204 DOI: 10.1016/s1473-3099(23)00778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 03/10/2024]
Abstract
The absence of a consensus-based reference standard for urinary tract infection (UTI) research adversely affects the internal and external validity of diagnostic and therapeutic studies. This omission hinders the accumulation of evidence for a disease that imposes a substantial burden on patients and society, particularly in an era of increasing antimicrobial resistance. We did a three-round Delphi study involving an international, multidisciplinary panel of UTI experts (n=46) and achieved a high degree of consensus (94%) on the final reference standard. New-onset dysuria, urinary frequency, and urinary urgency were considered major symptoms, and non-specific symptoms in older patients were not deemed indicative of UTI. The reference standard distinguishes between UTI with and without systemic involvement, abandoning the term complicated UTI. Moreover, different levels of pyuria were incorporated in the reference standard, encouraging quantification of pyuria in studies done in all health-care settings. The traditional bacteriuria threshold (105 colony-forming units per mL) was lowered to 104 colony-forming units per mL. This new reference standard can be used for UTI research across many patient populations and has the potential to increase homogeneity between studies.
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Affiliation(s)
- Manu P Bilsen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands.
| | - Simon P Conroy
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Caroline Schneeberger
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Tamara N Platteel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands; Department of Public Health and Primary Care, The Hague Health Campus, Leiden University Medical Center, The Hague, Netherlands
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | - Suzanne E Geerlings
- Amsterdam UMC, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Florian Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, MN, USA
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Merel M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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Yeung GYC, Smalbrugge M, van Buul LW, Rutten JJS, van Houten P, Gerridzen IJ, de Bruijne MC, Joling KJ, Hertogh CMPM. Urinary Tract Infection Guideline Adherence in a Dutch Sentinel Nursing Home Surveillance Network. J Am Med Dir Assoc 2024; 25:105037. [PMID: 38796171 DOI: 10.1016/j.jamda.2024.105037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To investigate guideline adherence 3 years after the introduction of a national guideline on urinary tract infections (UTIs) in frail older adults. Appropriate use of urine dipstick tests, treatment decisions, and antibiotic drug choices in residents with (suspected) UTIs without a catheter were examined. DESIGN Observational prospective study. SETTING AND PARTICIPANTS Nineteen nursing homes participating in a Dutch Sentinel Nursing Home Surveillance Network. METHODS As of September 2021, for a 3-month period, medical practitioners recorded additional clinical information in the electronic health record in case of a (suspected) UTI. Based on this information, adherence to guideline recommendations was assessed. Nonadherence was classified into 2 categories: (1) "intentional nonadherence" as reported by practitioners and (2) "nonadherence otherwise" applied to all other cases where the recorded information was discordant with the guideline recommendations. RESULTS A total of 532 cases of (suspected) UTIs from 469 residents were analyzed. In 455 cases (86%), dipsticks were used. For the 231 cases where clinical signs and symptoms already indicated no UTI treatment according to the guideline, a dipstick was still inappropriately ordered in 196 cases (85%). The decision to prescribe or withhold antibiotics was in 69% of the cases adherent, in 6% intentionally nonadherent, and in 25% nonadherent otherwise. The type of prescribed antibiotic was adherent to the recommended antibiotics for cystitis in 88% and for UTIs with signs of tissue invasion in 48%. Overall, for 40% of suspected UTIs, adherence to all relevant recommendations could be established, and in 9% practitioners reported intentional nonadherence to the guideline. CONCLUSIONS AND IMPLICATIONS There is considerable room for improvement in all clinical stages of managing a suspected UTI in Dutch nursing homes, particularly with regard to the importance of patient's clinical signs and symptoms for appropriate dipstick use and antibiotic UTI treatments.
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Affiliation(s)
- Gary Y C Yeung
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Laura W van Buul
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jeanine J S Rutten
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Paul van Houten
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ABR Zorgnetwerken Noord-Holland en Flevoland, Amsterdam, the Netherlands
| | - Ineke J Gerridzen
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Atlant, Korsakoff Centre of Expertise, Beekbergen, the Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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8
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Alves J, Prendki V, Chedid M, Yahav D, Bosetti D, Rello J. Challenges of antimicrobial stewardship among older adults. Eur J Intern Med 2024; 124:5-13. [PMID: 38360513 DOI: 10.1016/j.ejim.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Older adults hospitalized in internal medicine wards or long-term care facilities (LTCF) are progressively increasing. Older adults with multimorbidity are more susceptible to infections, as well as to more vulnerable to adverse effects (and interactions) of antibiotics, resulting in a need for effective and safer strategies for antimicrobial stewardship (ASM), both in hospitalization wards and long-term care facilities. Studies on antimicrobial stewardship in older patients are scarce and guidelines are required. Given the peculiarities of the optimization of antimicrobial prescription in individual older adults for common infections, tactics to overcome barriers need an update. The use of rapid diagnosis tests, biomarkers, de-escalation and switching from intravenous to oral/subcutaneous therapy strategies are examples of successful AMS interventions. AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness. Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.
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Affiliation(s)
- Joana Alves
- Infectious Diseases Specialist, Head of Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance, Hospital de Braga, Portugal.
| | - Virginie Prendki
- Department of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland; Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Marie Chedid
- Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - Davide Bosetti
- Department of Infectious Disease, Geneva University Hospital, Switzerland; Infection Control Programme and WHO Collaborating Centre for Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jordi Rello
- Medicine Department, Universitat Internacional de Catalunya, Spain; Clinical Research Pneumonia and Sepsis (CRIPS) Research Group-Vall d'Hebrón Institute Research (VHIR), Barcelona, Spain; Formation, Recherche, Evaluation (FOREVA), CHU Nîmes, Nîmes, France
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9
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Lin M, Chen B, Xiao L, Zhang L. Publication Trends of Research on Adverse Event and Patient Safety in Nursing Research: A 8-Year Bibliometric Analysis. J Patient Saf 2024; 20:288-298. [PMID: 38314796 DOI: 10.1097/pts.0000000000001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Adverse events (AEs), which are associated with medical system instability, poor clinical outcomes, and increasing socioeconomic burden, represent a negative outcome of the healthcare system and profoundly influence patient safety. However, research into AEs remains at a developmental stage according to the existing literature, and no previous studies have systematically reviewed the current state of research in the field of AEs. Therefore, the aims of this study were to interpret the results of published research in the field of AEs through bibliometric analysis and to analyze the trends and patterns in the data, which will be important for subsequent innovations in the field. METHODS A statistical and retrospective visualization bibliometric analysis was performed on July 28, 2022. The research data were extracted from the Web of Science Core Collection, and bibliometric citation analysis was performed using Microsoft Excel, VOSviewer 1.6.18, CiteSpace 6.1.R2, and the Online Analysis Platform of Literature Metrology ( http://bibliometric.com/ ). RESULTS A total of 1035 publications on AEs were included in the analysis. The number of articles increased annually from 2014 to 2022. Among them, the United States (n = 318) made the largest contribution, and Chung-Ang University (n = 20) was the affiliation with the greatest influence in this field. Despite notable international cooperation, a regional concentration of research literature production was observed in economically more developed countries. In terms of authors, Stone ND (n = 9) was the most productive author in the research of AEs. Most of the publications concerning AEs were cited from internationally influential nursing journals, and the Journal of Nursing Management (n = 62) was the most highly published journal. Regarding referencing, the article titled "Medical error-the third leading cause of death in the US" received the greatest attention on this topic (51 citations). CONCLUSIONS After systematically reviewed the current state of research in the field of AEs through bibliometric analysis, and AEs highlighted medication errors, patient safety, according reporting, and quality improvement as essential developments and research hotspots in this field. Furthermore, thematic analysis identified 2 new directions in research, concerned with psychological safety, nurse burnout, and with important research value and broad application prospects in the future.
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Affiliation(s)
| | - Bei Chen
- From the Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University
| | - Leyao Xiao
- School of Nursing, ZunyiMedical University
| | - Li Zhang
- The Affiliated Hospital of Zunyi Medical University, Zunyi
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10
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Froom P, Shimoni Z. Laboratory Tests, Bacterial Resistance, and Treatment Options in Adult Patients Hospitalized with a Suspected Urinary Tract Infection. Diagnostics (Basel) 2024; 14:1078. [PMID: 38893605 PMCID: PMC11172264 DOI: 10.3390/diagnostics14111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Patients treated for systemic urinary tract infections commonly have nonspecific presentations, and the specificity of the results of the urinalysis and urine cultures is low. In the following narrative review, we will describe the widespread misuse of urine testing, and consider how to limit testing, the disutility of urine cultures, and the use of antibiotics in hospitalized adult patients. Automated dipstick testing is more precise and sensitive than the microscopic urinalysis which will result in false negative test results if ordered to confirm a positive dipstick test result. There is evidence that canceling urine cultures if the dipstick is negative (negative leukocyte esterase, and nitrite) is safe and helps prevent the overuse of urine cultures. Because of the side effects of introducing a urine catheter, for patients who cannot provide a urine sample, empiric antibiotic treatment should be considered as an alternative to culturing the urine if a trial of withholding antibiotic therapy is not an option. Treatment options that will decrease both narrower and wider spectrum antibiotic use include a period of watching and waiting before antibiotic therapy and empiric treatment with antibiotics that have resistance rates > 10%. Further studies are warranted to show the option that maximizes patient comfort and safety.
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Affiliation(s)
- Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya 4244916, Israel
- School of Public Health, University of Tel Aviv, Tel Aviv 6997801, Israel
| | - Zvi Shimoni
- The Adelson School of Medicine, Ariel University, Ariel 4070000, Israel;
- Sanz Medical Center, Laniado Hospital, Netanya 4244916, Israel
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11
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Redwood R, Claeys KC. The Diagnosis and Treatment of Adult Urinary Tract Infections in the Emergency Department. Emerg Med Clin North Am 2024; 42:209-230. [PMID: 38641388 DOI: 10.1016/j.emc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Emergency medicine has been called the art of "making complicated clinical decisions with limited information." This description is particularly relevant in the case of diagnosis and treatment of urinary tract infections (UTIs). Although common, UTIs are often challenging to diagnose given the presence of non-specific signs and symptoms and over-reliance on laboratory findings. This review provides an interdisciplinary interpretation of the primary literature and practice guidelines, with a focus on diagnostic and antimicrobial stewardship in the emergency department.
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Affiliation(s)
- Robert Redwood
- Bozeman Health Emergency Department, 915 Highland Avenue, Bozeman, MT 59715, USA
| | - Kimberly C Claeys
- Department of Pharmacy Science and Health Outcomes Research, University of Maryland School of Pharmacy, 20 N Pine Street, Baltimore, MD 21201, USA.
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Hunold KM, Rozycki E, Brummel N. Optimizing Diagnosis and Management of Community-acquired Pneumonia in the Emergency Department. Emerg Med Clin North Am 2024; 42:231-247. [PMID: 38641389 PMCID: PMC11212456 DOI: 10.1016/j.emc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Pneumonia is split into 3 diagnostic categories: community-acquired pneumonia (CAP), health care-associated pneumonia, and ventilator-associated pneumonia. This classification scheme is driven not only by the location of infection onset but also by the predominant associated causal microorganisms. Pneumonia is diagnosed in over 1.5 million US emergency department visits annually (1.2% of all visits), and most pneumonia diagnosed by emergency physicians is CAP.
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Affiliation(s)
- Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, 376 W 10th Avenue, 760 Prior Hall, Columbus, OH 43220, USA.
| | - Elizabeth Rozycki
- Emergency Medicine, Department of Pharmacy, The Ohio State University, 376 W 10th Avenue, 760 Prior Hall, Columbus, OH 43220, USA
| | - Nathan Brummel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, 376 W 10th Avenue, 760 Prior Hall, Columbus, OH 43220, USA
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13
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Zahran A, Hussein HA, Thabet AA, Izzaldin MR, Wardany AA, Sobhy A, Bashir MA, Afifi MM, Ali WA, Rayan A, Saad K, Khalaf MG, Ahmed ME, Sayed NG. Immune Checkpoints Receptors Expression of Macrophage/Monocytes in Response to Acute Viral Respiratory Infection. J Clin Med Res 2024; 16:232-242. [PMID: 38855783 PMCID: PMC11161185 DOI: 10.14740/jocmr5098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Background We aimed to monitor the phenotypic changes in macrophages and their polarization in patients with acute viral respiratory diseases, including coronavirus disease diagnosis, focusing on the variations in the percentages of macrophages and monocytes and their sub-populations in those patients compared to healthy control. Moreover, we defined the correlation between macrophage subtypes and some inflammatory indices. Methods Twenty-seven patients with clinical and radiologic diagnosis of acute viral respiratory infection admitted in Al-Azhar and Assiut University hospitals were recruited. Fresh peripheral blood samples were collected from all patients and healthy controls for flow cytometric analysis using BD FACSCanto II analyzer equipped with three lasers. Results Compared to healthy controls, accumulation of cluster of differentiation (CD)11B+CD68+ macrophages (M) (P = 0.018), CD274+ M1 (P = 0.01), CD274+ M2 (P < 0.001), and CD80-CD206+ M2 (P = 0.001) was more evident in patients. Moreover, CD273+ M2 (P = 0.03), CD80+CD206- M1 (P = 0.002), and CD80+CD86+ M1 (P = 0.002) were highly expressed in controls compared with patients. Conclusion The examination of clinical specimens obtained from patients with signs of acute respiratory viral infection showed the role of the macrophage in the immune response. Dysfunction in macrophages results in heightened immune activity and inflammation, which plays a role in the progression of viral diseases and the emergence of accompanying health issues. This malfunction in macrophages is a common characteristic seen in various viruses, making it a promising focus for antiviral therapies with broad applicability. The immune checkpoint could be a target for immune modulation in patients with severe symptoms.
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Affiliation(s)
- Asmaa Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Hosni A. Hussein
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
| | - Ali A. Thabet
- Department of Zoology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
| | - Mohamed R. Izzaldin
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
| | - Ahmed A. Wardany
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt
| | - Ali Sobhy
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
| | - Mohamed A. Bashir
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
| | - Magdy M. Afifi
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Nasr City 11884, Cairo, Egypt
| | - Wageeh A. Ali
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal Rayan
- Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Mahmoud Elsaeed Ahmed
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Noha G. Sayed
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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14
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Jain S, Patel RB, Vala L, Kinthada S, Patel N, Jain S, Khan T, Nanjundappa A, Sirekulam V, Naik N, Siripuram C, Gill H. Missing Renal Stone Diagnosis in Dementia Patients With Recurrent Urinary Tract Infections: A Case Report and Literature Review. Cureus 2024; 16:e58908. [PMID: 38800185 PMCID: PMC11117170 DOI: 10.7759/cureus.58908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
In older adults, diagnosing, treating, and preventing urinary tract infections (UTIs) can be challenging. This case is of an 82-year-old female of white descent, who was admitted to a post-acute care facility following hospitalization for delirium and a UTI. Hypoactive delirium may be the only clinical manifestation of recurrent UTI. Due to challenges in obtaining a history from this patient with dementia, she had to be admitted multiple times for sepsis. During her final hospitalization, a CT scan of the abdomen and pelvis was ordered, which revealed an obstructed kidney stone as the cause of her recurrent UTIs. Recurrent UTIs especially in patients with dementia should prompt further imaging to look for kidney stones. Factors like dehydration and poor oral intake are risk factors for kidney stones, which patients with dementia are susceptible to.
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Affiliation(s)
- Sakshi Jain
- Department of Geriatrics, Hackensack University Medical Center, Hackensack, USA
| | | | - Lovekumar Vala
- Department of Anatomy, Shantabaa Medical College, Amreli, IND
| | - SudhaRani Kinthada
- Department of Obstetrics and Gynecology, Rangaraya Medical College, Kakinada, IND
| | - Neel Patel
- Department of Medical Education, GMERS Medical College Gotri, Vadodara, IND
| | - Shikha Jain
- Department of Medicine, MVJ Medical College and Research Hospital, Bengaluru, IND
| | - Tanzina Khan
- Department of Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | | | - Vaishnavi Sirekulam
- Department of Medicine, Vijayanagar Institute of Medical Sciences, Ballari, IND
| | - Nishthaben Naik
- Department of Health & Family Welfare, Primary Health Center, Bigri, Navsari, IND
| | - Chandu Siripuram
- Department of Hospital Medicine, Geisinger Medical Center, Scranton, USA
| | - Harmeet Gill
- Department of Medicine, HopeHealth, Florence, USA
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15
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Obaid JMAS, Al-Gashaa FAS. Bacterial Infection versus Viral Infection Preference of ABO Blood Group Phenotype Patients. Jpn J Infect Dis 2024; 77:112-117. [PMID: 38030273 DOI: 10.7883/yoken.jjid.2023.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Several studies have established an association between the blood group type and susceptibility to infections. This study aimed to evaluate a correlation between the blood group type and the susceptibility to infection. A total of 558 patients were enrolled in this study who attended at the Althawra Hospital, Ibb City, from March to August 2018. Blood samples were analyzed for complete blood count and blood group. We observed a high frequency of infections affecting the digestive system (26.4%), while the least affected system was the urogenital system 5.9%. Patients with A blood group exhibit an increased probability to be infected by viruses than they do for bacteria (odds ratio [OR] = 1.430; 95% confidence interval [CI] = 1.005 to 2.035; P = 0.05 and OR = 0.098; 95% CI = 0.064 to 0.148; P < 0.0001, respectively). It was observed that blood group A individuals were more susceptible to infection with hepatitis B virus than were the other groups (P = 0.041; OR = 1.704, 95% CI = 1.053-2.773). The liklihood of O blood group patients experiencing urogenital infections was less than that of non-O blood group patients one third (OR = 0.353, 95% CI = 0.158-0.789; P = 0.014). This study corroborates previous findings that demonstrated that certain blood groups are more prone to infection by one agent than are patients with other blood groups.
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Affiliation(s)
| | - Fadhl Ahmed Saeed Al-Gashaa
- Department of Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, Ibb University, Yemen
- Department of Biology, Al-Farabi University College, Iraq
- Department of Biotechnology, University of Baghdad College of Science, Iraq
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16
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Khalfay N, Murray K, Shimabukuro J, Chiang JN, Ackerman AL. Antibiotic Switches in Urinary Tract Infection Are Associated With Atypical Symptoms and Emergent Care. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:256-263. [PMID: 38484240 PMCID: PMC10947062 DOI: 10.1097/spv.0000000000001464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Given worsening global antibiotic resistance, antimicrobial stewardship aims to use the shortest effective duration of the most narrow-spectrum, effective antibiotic for patients with specific urinary symptoms and laboratory testing consistent with urinary tract infection (UTI). Inappropriate treatment and unnecessary antibiotic switching for UTIs harms patients in a multitude of ways. OBJECTIVE This study sought to analyze antibiotic treatment failures as measured by antibiotic switching for treatment of UTI in emergent and ambulatory care. STUDY DESIGN For this retrospective cohort study, 908 encounters during July 2019 bearing a diagnostic code for UTI/cystitis in a single health care system were reviewed. Urinary and microbiological testing, symptoms endorsed at presentation, and treatments prescribed were extracted from the medical record. RESULTS Of 908 patients diagnosed with UTI, 64% of patients (579/908) received antibiotics, 86% of which were empiric. All patients evaluated in emergent care settings were prescribed antibiotics empirically in contrast to 71% of patients in ambulatory settings (P < 0.001). Of patients given antibiotics, 89 of 579 patients (15%, 10% of all 908 patients) were switched to alternative antibiotics within 28 days. Emergent care settings and positive urine cultures were significantly associated with increased antibiotic switching. Patients subjected to switching tended to have higher rates of presenting symptoms inconsistent with UTI. CONCLUSIONS Empiric treatment, particularly in an emergent care setting, was frequently inappropriate and associated with increasing rates of antibiotic switching. Given the profound potential contribution to antibiotic resistance, these findings highlight the need for improved diagnostic and prescribing accuracy for UTI.
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Affiliation(s)
- Nuha Khalfay
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kristen Murray
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Jeffrey N. Chiang
- Department of Computational Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - A. Lenore Ackerman
- Departments of Urology and Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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17
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Reid DM, Khadka M, Kahlon S, Chalasani N, Kass K. Severe Shewanella Cellulitis Following Saltwater Exposure in an Elderly Patient. Cureus 2024; 16:e55724. [PMID: 38586666 PMCID: PMC10998643 DOI: 10.7759/cureus.55724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Shewanella algae is an opportunistic Gram-negative bacillus primarily found in marine environments. It can cause a range of infections in humans, from superficial soft tissue infections to more severe conditions like bacteremia, otitis, and hepatobiliary infections. While infections are rare, they can be significant, leading to complications such as sepsis and tissue necrosis. We present the case of severe cellulitis caused by Shewanella in an 88-year-old patient with multiple comorbidities. Following a blue crab pinch and consequent saltwater exposure, the patient developed severe cellulitis, sepsis, delirium, and atrial fibrillation. Despite these complications and the patient's age, a prompt diagnosis and a combination of antibiotic treatments led to a successful recovery. This case is notable for its illustration of the potential severity and diverse clinical presentation of Shewanella infections. It highlights the importance of considering Shewanella as a possible pathogen in cases of saltwater exposure and teaches management in elderly, multi-morbid patients.
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Affiliation(s)
- Devaun M Reid
- Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Monica Khadka
- Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Sunny Kahlon
- Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Nishanth Chalasani
- Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Kathryn Kass
- Infectious Disease, University of South Florida, Tampa, USA
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18
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Okonkwo RI, Grant G, Ndukwe H, Mohammed ZA, Khan S. Assessing the Appropriateness of Antimicrobial Prescribing in the Community Setting: A Scoping Review. Open Forum Infect Dis 2024; 11:ofad670. [PMID: 38524228 PMCID: PMC10959551 DOI: 10.1093/ofid/ofad670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Indexed: 03/26/2024] Open
Abstract
Background This scoping review examined the concept and scope of appropriateness of antimicrobial prescribing in the community setting and how it has been measured. Methods Utilizing the Joanna Briggs Institute's methodology, we appraised peer-reviewed articles and unpublished studies, focusing on the US, UK, Canada, and Australia, with no limit to date. Results Four basic components of antimicrobial prescribing to be evaluated during assessment of antimicrobial appropriateness in the community setting were identified: diagnosis for infection or indication for antimicrobial therapy, choice of antimicrobial therapy, dosing, and duration of therapy. The benchmark for definition of appropriateness is crucial in assessing antimicrobial prescribing appropriateness. The use of recommended guidelines as a benchmark is the standard for appropriate antimicrobial therapy, and when necessary, susceptibility testing should be explored. Conclusions Studies evaluating the appropriateness of antimicrobial prescribing should assess these components of antimicrobial prescribing, and this should be clearly stated in the aim and objectives of the study.
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Affiliation(s)
- Rose I Okonkwo
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Gary Grant
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | - Henry Ndukwe
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
| | | | - Sohil Khan
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
- Manipal College of Pharmaceutical Sciences and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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19
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Jokanovic N, Lee SJ, Haines T, Hilmer SN, Jeon YH, Travis L, Ayton D, Watson E, Tsindos T, Stewardson AJ, Stuart RL, Cheng AC, Peel TN, Peleg AY. Pilot study to evaluate the need and implementation of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care. JAC Antimicrob Resist 2024; 6:dlae016. [PMID: 38371999 PMCID: PMC10873136 DOI: 10.1093/jacamr/dlae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives To evaluate the need and feasibility of a nurse-led antimicrobial stewardship (AMS) programme in two Australian residential aged care homes (RACHs) to inform a stepped-wedged, cluster randomized controlled trial (SW-cRCT). Methods A mixed-methods pilot study of a nurse-led AMS programme was performed in two RACHs in Victoria, Australia (July-December 2019). The AMS programme comprised education, infection assessment and management guidelines, and documentation to support appropriate antimicrobial use in urinary, lower respiratory and skin/soft tissue infections. The programme was implemented over three phases: (i) pre-implementation education and integration (1 month); (ii) implementation of the intervention (3 months); and (iii) post-intervention evaluation (1 month). Baseline RACH and resident data and weekly infection and antimicrobial usage were collected and analysed descriptively to evaluate the need for AMS strategies. Feedback on intervention resources and implementation barriers were identified from semi-structured interviews, an online staff questionnaire and researcher field notes. Results Six key barriers to implementation of the intervention were identified and used to refine the intervention: aged care staffing and capacity; access to education; resistance to practice change; role of staff in AMS; leadership and ownership of the intervention at the RACH and organization level; and family expectations. A total of 61 antimicrobials were prescribed for 40 residents over the 3 month intervention. Overall, 48% of antibiotics did not meet minimum criteria for appropriate initiation (respiratory: 73%; urinary: 54%; skin/soft tissue: 0%). Conclusions Several barriers and opportunities to improve implementation of AMS in RACHs were identified. Findings were used to inform a revised intervention to be evaluated in a larger SW-cRCT.
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Affiliation(s)
- Natali Jokanovic
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sue J Lee
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laura Travis
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton Victoria, Australia
| | - Eliza Watson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tess Tsindos
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton Victoria, Australia
| | - Andrew J Stewardson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rhonda L Stuart
- Public Health and Infection Prevention, Monash Health, Monash Medical Centre, Clayton, Victoria, Australia
| | - Allen C Cheng
- Monash Infectious Diseases, Monash Health, Monash Medical Centre, Clayton, Victoria, Australia
| | - Trisha N Peel
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Monash Biomedicine Discovery Institute, Infection and Immunity Theme, Department of Microbiology, Monash University, Clayton, Victoria, Australia
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20
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Chakraborty D, Debnath F, Majumdar A, Chakrabarti A, Sharma M, Walia K, Deb AK, Dutta S. Diagnostic validation study of rapid urinary tract infection diagnosis kit at peripheral health facilities of West Bengal, India. Sci Rep 2024; 14:297. [PMID: 38167537 PMCID: PMC10761820 DOI: 10.1038/s41598-023-49489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Patients reporting to the outpatient departments of peripheral health care settings in India with symptoms of urinary tract infection (UTI) receive one or the other antibiotic before culture confirmation and out of the total culture confirmed UTI cases, in less than one third cases the prescribed antibiotics matches to the antibiotic sensitivity test result. Hence, in this study, an indigenous point-of-care (POCT) rapid diagnostic kit (Rapidogram) for UTI was validated against conventional urine culture and sensitivity to understand its possible applicability at peripheral health care settings. This cross-sectional study was conducted during November 2021 to June 2022 in OPDs of two peripheral hospitals. A sample size of 300 was calculated using prevalence of urinary tract infection (UTI) as 33% for sensitivity and specificity using Buderer's formula. Urine specimens were collected following standard aseptic procedures from the recruited suspected UTI cases and transferred to laboratory maintaining the cold chain. The validation work up was done in two sections: lab validation and field validation. Out of 300 urine samples, 29 were found positive for the growth of UTI pathogen by both methods and 267 were found negative by both methods. Thus, the kit shows very high specificity (99.6%; 97.9-99.9%) and considerably high sensitivity (90.6%; 74.9-98.0%). We also observed higher PPV, NPV, test accuracy (> 96%). Diagnostic Odds Ratio and Youden index were respectively 2581 and 0.89. Clinical data showed that 44% of the suspected UTI cases were prescribed at least one antibiotic before urine test. Mostly they received Norfloxacin whereas the mostly identified organism E.coli was sensitive to Nitrofurantoin. In the context of absence of microbiology facility at peripheral setting and rampant empirical use of antibiotics in UTI, this highly specific and sensitive POCT for UTI may be used as it not only identifies the organism, also shows the antibiotic sensitivity pattern.
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Affiliation(s)
- Debjit Chakraborty
- ICMR-National Institute of Cholera and Enteric Diseases, P-33, CIT Road, Scheme-XM, Beliaghata, Kolkata, 10, India
| | - Falguni Debnath
- ICMR-National Institute of Cholera and Enteric Diseases, P-33, CIT Road, Scheme-XM, Beliaghata, Kolkata, 10, India.
| | - Agniva Majumdar
- ICMR-National Institute of Cholera and Enteric Diseases, P-33, CIT Road, Scheme-XM, Beliaghata, Kolkata, 10, India
| | - Atreyi Chakrabarti
- Department of Health and Family Welfare, Government of West Bengal, South 24 Pargana, India
| | - Monica Sharma
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Kamini Walia
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Alok Kumar Deb
- ICMR-National Institute of Cholera and Enteric Diseases, P-33, CIT Road, Scheme-XM, Beliaghata, Kolkata, 10, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, P-33, CIT Road, Scheme-XM, Beliaghata, Kolkata, 10, India
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21
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Temte JL, Checovich MM, Barlow S, Shult PA, Reisdorf E, Haupt TE, Hamrick I, Mundt MP. Rapid Detection of Influenza Outbreaks in Long-Term Care Facilities Reduces Emergency Room Visits and Hospitalization: A Randomized Trial. J Am Med Dir Assoc 2023; 24:1904-1909. [PMID: 37421970 DOI: 10.1016/j.jamda.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To assess whether the use of rapid influenza diagnostic tests (RIDTs) for long-term care facility (LTCF) residents with acute respiratory infection is associated with increased antiviral use and decreased health care utilization. DESIGN Nonblinded, pragmatic, randomized controlled trial evaluating a 2-part intervention with modified case identification criteria and nursing staff-initiated collection of nasal swab specimen for on-site RIDT. SETTING AND PARTICIPANTS Residents of 20 LTCFs in Wisconsin matched by bed capacity and geographic location and then randomized. METHODS Primary outcome measures, expressed as events per 1000 resident-weeks, included antiviral treatment courses, antiviral prophylaxis courses, total emergency department (ED) visits, ED visits for respiratory illness, total hospitalizations, hospitalizations for respiratory illness, hospital length of stay, total deaths, and deaths due to respiratory illness over 3 influenza seasons. RESULTS Oseltamivir use for prophylaxis was higher at intervention LTCFs [2.6 vs 1.9 courses per 1000 person-weeks; rate ratio (RR) 1.38, 95% CI 1.24-1.54; P < .001]; rates of oseltamivir use for influenza treatment were not different. Rates of total ED visits (7.6 vs 9.8/1000 person-weeks; RR 0.78, 95% CI 0.64-0.92; P = .004), total hospitalizations (8.6 vs 11.0/1000 person-weeks; RR 0.79, 95% CI 0.67-0.93; P = .004), and hospital length of stay (35.6 days vs 55.5 days/1000 person-weeks; RR 0.64, 95% CI 0.0.59-0.69; P < .001) were lower at intervention as compared to control LTCFs. No significant differences were noted for respiratory-related ED visits or hospitalizations or in rates for all-cause or respiratory-associated mortality. CONCLUSIONS AND IMPLICATIONS The use of low threshold criteria to trigger nursing staff-initiated testing for influenza with RIDT resulted in increased prophylactic use of oseltamivir. There were significant reductions in the rates of all-cause ED visits (22% decline), hospitalizations (21% decline), and hospital length of stay (36% decline) across 3 combined influenza seasons. No significant differences were noted in respiratory-associated and all-cause deaths between intervention and control sites.
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Affiliation(s)
- Jonathan L Temte
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA.
| | - Mary M Checovich
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Shari Barlow
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Peter A Shult
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Thomas E Haupt
- Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA
| | - Irene Hamrick
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
| | - Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, USA
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22
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Grey B, Upton M, Joshi LT. Urinary tract infections: a review of the current diagnostics landscape. J Med Microbiol 2023; 72. [PMID: 37966174 DOI: 10.1099/jmm.0.001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Urinary tract infections are the most common bacterial infections worldwide. Infections can range from mild, recurrent (rUTI) to complicated (cUTIs), and are predominantly caused by uropathogenic Escherichia coli (UPEC). Antibiotic therapy is important to tackle infection; however, with the continued emergence of antibiotic resistance there is an urgent need to monitor the use of effective antibiotics through better stewardship measures. Currently, clinical diagnosis of UTIs relies on empiric methods supported by laboratory testing including cellular analysis (of both human and bacterial cells), dipstick analysis and phenotypic culture. Therefore, development of novel, sensitive and specific diagnostics is an important means to rationalise antibiotic therapy in patients. This review discusses the current diagnostic landscape and highlights promising novel diagnostic technologies in development that could aid in treatment and management of antibiotic-resistant UTIs.
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Affiliation(s)
- Braith Grey
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | - Mathew Upton
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | - Lovleen Tina Joshi
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
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23
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Mylotte JM. Determining the Appropriateness of Initiating Antibiotic Therapy in Nursing Home Residents. J Am Med Dir Assoc 2023; 24:1619-1628. [PMID: 37572691 DOI: 10.1016/j.jamda.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/14/2023]
Abstract
One approach for improving antibiotic prescribing in nursing homes is evaluating appropriateness of initiating antibiotic therapy. However, determining appropriateness has been a challenge. To investigate this problem literature review identified studies evaluating appropriateness of initiating antibiotic therapy in nursing homes. Two criteria were used most often to assess appropriateness: infection surveillance criterion or criteria specifically designed to assist clinicians for prescribing antibiotics. Development of these criteria and results of studies using these criteria were reviewed. There was considerable variability in percentage appropriateness of initiating therapy for these criteria, variation in the methodology for conducting these studies, and limitations of the criteria. The main limitation of infection surveillance criteria is that they are specifically designed to be highly specific but this results in low sensitivity. Thus, surveillance criteria should not be used for assessing appropriateness of antibiotic therapy. The other criterion is limited because it uses only localizing signs and symptoms of infection and these findings may not be documented in the medical record when evaluating appropriateness retrospectively. Several alternative methods to assess appropriateness were identified but evaluation of these methods have not been published. Several changes are suggested to improve the evaluation of the appropriateness of initiating antibiotic therapy in nursing home residents: confirmation by the Department of Health and Human Services and the Centers for Medicare & Medicaid Services that surveillance definitions should not be used to evaluate appropriateness; develop and validate definitions of clinical infections in residents; standardize methods to evaluate appropriateness prospectively by the facility antimicrobial stewardship program; educate clinicians and nursing staff regarding the criteria for assessing appropriateness; and investigate the influence of provider-, resident-, family-, and facility-level factors on antibiotic use in nursing home residents.
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Affiliation(s)
- Joseph M Mylotte
- Division of Infectious Diseases, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY.
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24
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Venditti N, Petronio GP, Pinti M, Cutolo G, Pietrangelo L, Massini L, Magnifico I, Cutuli MA, Petrone F, Papini S, Di Marco R, Corbi G. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes. Open Med (Wars) 2023; 18:20230822. [PMID: 37900963 PMCID: PMC10612528 DOI: 10.1515/med-2023-0822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
The aim of this retrospective cohort study is to understand if and how much the preventive self-isolation approach might have been a valid model to avoid care-related infection, not only from COVID-19 but also from other non-viral infectious diseases. From March to May 2020, the healthcare and management staff of the Villa Santa Maria long-term care facilities, located in the village of Montenero di Bisaccia (Campobasso, Molise, Italy), decided to carry out a preventive self-isolation plan to safeguard the residents from SARS-CoV-2. The impact on other infectious diseases was evaluated by analyzing the antibiotic therapies prescription trend among the inpatients. Our data showed that although self-isolation protected residents and caregivers from SARS-CoV-2, it can also be associated with mobility reduction, leading to an increase in bedridden pathologies, namely, pressure ulcers and pressure sores. The simultaneous isolation of residents and caregivers in the same location significantly reduced any outside influence as a cause of possible infections.
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Affiliation(s)
- Noemi Venditti
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Giulio Petronio Petronio
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Melania Pinti
- Istituto Dottrina Cristiana (Largo Istituto Dottrina Cristiana, 1, 67100 L’Aquila AQ), U.O. RSD e Casa di Riposo “Villa Santa Maria”, Montenero di Bisaccia (CB)86036, Italy
| | - Giovanni Cutolo
- Istituto Dottrina Cristiana (Largo Istituto Dottrina Cristiana, 1, 67100 L’Aquila AQ), U.O. RSD e Casa di Riposo “Villa Santa Maria”, Montenero di Bisaccia (CB)86036, Italy
| | - Laura Pietrangelo
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Laura Massini
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Irene Magnifico
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Marco Alfio Cutuli
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Federica Petrone
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Stefano Papini
- UO Laboratorio Analisi, Responsible Research Hospital, Campobasso, Italy
| | - Roberto Di Marco
- Department of Medicine, Health Science “V. Tiberio”, Università degli Studi del Molise, Via De Sanctis snc, Campobasso86100, Italy
| | - Graziamaria Corbi
- Department of Translational Medical Sciences, University of Naples Federico IINapoli80126, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Campania Region section, Florence, Italy
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25
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Wimmer B. Urinary tract infections in long-term care: Improving outcomes through evidence-based practice. Nursing 2023; 53:30-35. [PMID: 37734016 DOI: 10.1097/01.nurse.0000977568.34589.9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT Urinary tract infections (UTI) are the most common infections in long-term care (LTC) facilities, yet clinical judgment rather than evidence is most often used in evaluation and treatment. This article recounts the implementation of an evidence-based practice evaluation and treatment protocol at an LTC facility to reduce the number of residents with a UTI.
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Affiliation(s)
- Brenda Wimmer
- Brenda Wimmer is an assistant professor of graduate nursing at Morningside University at Sioux City, Iowa
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26
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Czwikla J, Wandscher K, Helbach J, Fassmer AM, Schmiemann G, Hoffmann F. Prevalence of indwelling urinary catheters in nursing home residents: Systematic review. Int J Nurs Stud 2023; 145:104555. [PMID: 37421830 DOI: 10.1016/j.ijnurstu.2023.104555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND This systematic review examines the prevalence of indwelling urinary catheters in nursing home residents. METHODS MEDLINE via PubMed, CINAHL, and EMBASE were searched from inception to 9 August 2022. Cross-sectional studies and longitudinal studies with cross-sectional analyses reporting catheter prevalence in nursing home residents were identified and summarized descriptively. Study quality was assessed using the Joanna Briggs Institute's tool. RESULTS Sixty-seven studies (92.5 % cross-sectional) were included. The reported number of included residents ranged from 73 to 110,656. The median catheter prevalence was 7.3 % (interquartile range 4.3-10.1 %; n = 65 studies). It was higher in Germany (10.2 % [9.7-12.8 %]; n = 15) than in the United States of America (9.3 % [6.3-11.9 %]; n = 9), United Kingdom (6.9 % [4.8-8.5 %]; n = 7), and Sweden (7.3 % [6.4-7.9 %]; n = 6). Furthermore, it was higher among men (17.0 % [16.0-26.0 %]) than among women (5.3 % [4.0-9.5 %]) (n = 9). Only one study investigated differences by age. The prevalence was higher for transurethral (5.7 % [5.6-7.2 %]; n = 12) than for suprapubic (1.2 % [0.6-2.5 %]; n = 13) catheters. Most catheterized residents were long-term catheterized (n = 6) and had their catheter changed within 3 months (n = 2). Symptomatic urinary tract infections were more common among catheterized than among non-catheterized residents (n = 4). DISCUSSION Catheter prevalence in nursing home residents varies between studies and countries. Prevalence differences by sex, age, and catheter type as well as duration of catheterization, catheter change intervals, and catheter-associated urinary tract infections are rarely reported because most studies do not primarily focus on catheters. Future studies should focus on the circumstances of urinary catheter use and care in nursing home residents. REGISTRATION AND FUNDING PROSPERO (29 August 2022; CRD42022354358); no funding.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany; Department of Health, Long-term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany.
| | - Kathrin Wandscher
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Jasmin Helbach
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Alexander M Fassmer
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Guido Schmiemann
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
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27
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Wretman CJ, Boynton MH, Preisser JS, Zimmerman S, Kistler CE. Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: A discrete choice experiment. Infect Control Hosp Epidemiol 2023; 44:1151-1154. [PMID: 36073169 DOI: 10.1017/ice.2022.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The overdiagnosis of urinary tract infections (UTIs) in nursing home residents is a significant public health threat. Using a discrete choice experiment and a diagnostic guideline, we examined which patient-level information was associated with the overdiagnosis of UTIs and found that urinalysis results and lower urinary tract status were most associated.
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Affiliation(s)
| | - Marcella H Boynton
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - John S Preisser
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Sheryl Zimmerman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Christine E Kistler
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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28
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Bilsen MP, Jongeneel RMH, Schneeberger C, Platteel TN, van Nieuwkoop C, Mody L, Caterino JM, Geerlings SE, Köves B, Wagenlehner F, Conroy SP, Visser LG, Lambregts MMC. Definitions of Urinary Tract Infection in Current Research: A Systematic Review. Open Forum Infect Dis 2023; 10:ofad332. [PMID: 37426954 PMCID: PMC10323732 DOI: 10.1093/ofid/ofad332] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023] Open
Abstract
Defining urinary tract infection (UTI) is complex, as numerous clinical and diagnostic parameters are involved. In this systematic review, we aimed to gain insight into how UTI is defined across current studies. We included 47 studies, published between January 2019 and May 2022, investigating therapeutic or prophylactic interventions in adult patients with UTI. Signs and symptoms, pyuria, and a positive urine culture were required in 85%, 28%, and 55% of study definitions, respectively. Five studies (11%) required all 3 categories for the diagnosis of UTI. Thresholds for significant bacteriuria varied from 103 to 105 colony-forming units/mL. None of the 12 studies including acute cystitis and 2 of 12 (17%) defining acute pyelonephritis used identical definitions. Complicated UTI was defined by both host factors and systemic involvement in 9 of 14 (64%) studies. In conclusion, UTI definitions are heterogeneous across recent studies, highlighting the need for a consensus-based, research reference standard for UTI.
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Affiliation(s)
- Manu P Bilsen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa M H Jongeneel
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Caroline Schneeberger
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Tamara N Platteel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
- Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Suzanne E Geerlings
- Amsterdam University Medical Center, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Florian Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Simon P Conroy
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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29
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Gülmez A, Ceylan AN, Özalp O. An Increasing Threat in Intensive Care Units, Evaluation of Multi-Drug-Resistant Myroides spp. Infections and Risk Factors. J Hosp Infect 2023:S0195-6701(23)00123-8. [PMID: 37094716 DOI: 10.1016/j.jhin.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Myroides species are gram-negative bacilli that are commonly found in soil and water, acting as low-level opportunistic pathogens and causing a variety of infections. AIM The purpose of this study is to assess the risk factors for multidrug-resistant Myroides infections, their association with comorbid illnesses, patient care, and their susceptibility to antibiotics. METHODS This retrospective analytical study was conducted in Istanbul Başakşehir Çam and Sakura City Hospital by including patients with Myroides spp isolation in their culture samples. The total hospitalization days, first isolation days, and 30-day mortality values of the patients were analysed statistically, and the significance level was accepted as p < 0.05. RESULTS Myroides spp. were isolated from 228 patients' 437 culture samples. Of these cases, 210 (92.1%) were classified as having asymptomatic bacteriuria, and 18 (7.9%) as having an infection caused by Myroides spp. 174 (76.3%) of these patients were followed up in the intensive care unit, and the total hospitalization days (median = 24.50) and the first isolation day (median = 9.50) of infected patients were shorter than colonized patients (p = 0.023, p = 0.030), no difference was found between 30-day mortality (p = 0.312). CONCLUSIONS It was observed that Myroides infections could be seen more frequently in patients who were hospitalized for a long time, used broad-spectrum antimicrobials, had invasive procedures, and had co-factors such as diabetes and cerebrovascular disease. In addition, it was observed that the resistance rates of M. odoratus strains were higher than M. odoratimimus strains and the use of quinolone antimicrobials in the treatment of patients with M. odoratimimus infection provided more cure.
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Affiliation(s)
- Abdurrahman Gülmez
- Istanbul Basaksehir Cam and Sakura City Hospital, Medical Microbiology Laboratory, Istanbul, Turkey.
| | - Ayse Nur Ceylan
- Istanbul Basaksehir Cam and Sakura City Hospital, Medical Microbiology Laboratory, Istanbul, Turkey.
| | - Onur Özalp
- Istanbul Basaksehir Cam and Sakura City Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
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30
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Bacteriuria in older adults triggers confusion in healthcare providers: A mindful pause to treat the worry. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e4. [PMID: 36714291 PMCID: PMC9879885 DOI: 10.1017/ash.2022.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 01/11/2023]
Abstract
The evidence base for refraining from screening for or treating asymptomatic bacteriuria (ASB) in older adults is strong, but both practices remain prevalent. Clinical confusion over how to respond to a change from baseline, when to order a urinalysis and urine culture, and what to do with a positive urine culture fuels unnecessary antibiotic use for ASB. If the provider can take a mindful pause to apply evidenced-based assessment tools, the resulting increased clarity in how to manage the situation can reduce overtreatment of ASB.
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31
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Schmidt N, Marujo V, Eckmanns T, Zacher B, Arvand M, Ruscher C. [Healthcare-associated infections and antimicrobial use in long-term care facilities. German results of the third European point prevalence survey HALT-3]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:863-871. [PMID: 35951042 PMCID: PMC9366828 DOI: 10.1007/s00103-022-03566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The essential role of infection prevention in long-term care facilities has become evident during the current SARS-CoV‑2 pandemic. In order to obtain a reliable database on nosocomial infections and antibiotic use, the European Centre for Disease Prevention and Control (ECDC) initiated the third point prevalence survey in European long-term care facilities from 2016 to 2017 (HALT-3). MATERIAL AND METHODS In Germany, 131 facilities with 10,565 residents participated voluntarily. On a single day in 2016, the number of nosocomial infections and/or uses of antibiotics as well as care characteristics and risk factors of the residents were recorded. Infections were documented based on symptoms using an algorithm in accordance with the McGeer surveillance criteria for long-term care facilities. RESULTS A nosocomial infection was documented in 177 residents, which corresponds to a prevalence of 1.7% (95% CI: 1.3-2.1), still low in comparison with the European prevalence (mean value 3.9%). Urinary tract infections were the most common infections at almost 50%, followed by respiratory, skin, and soft-tissue infections. The type of infection was consistent with the most common indications for antibiotic use. Antibiotic use was documented in 143 residents (prevalence of 1.4%, 95% CI: 1.1-1.7). The frequent use of fluoroquinolones with over 20% of all prescriptions was noticeable. CONCLUSIONS The establishment of facility-based surveillance of the most common infections and antibiotic consumption, together with the creation of guidelines specifically tailored to the geriatric population, could contribute to improving infection prevention and control as well as a more rational use of antibiotics, thus increasing the quality and safety of care.
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Affiliation(s)
- Nicole Schmidt
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland.
| | - Vanda Marujo
- Fachgebiet 14 - Angewandte Infektions- und Krankenhaushygiene, Robert Koch-Institut, Berlin, Deutschland
| | - Tim Eckmanns
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Benedikt Zacher
- Fachgebiet 37 - Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Seestr. 10, 13353, Berlin, Deutschland
| | - Mardjan Arvand
- Fachgebiet 14 - Angewandte Infektions- und Krankenhaushygiene, Robert Koch-Institut, Berlin, Deutschland
| | - Claudia Ruscher
- Fachgebiet 14 - Angewandte Infektions- und Krankenhaushygiene, Robert Koch-Institut, Berlin, Deutschland
- Landesamt für Gesundheit und Soziales (LAGeSo), Berlin, Deutschland
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32
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Gaspard P, Ambert-Balay K, Mosnier A, Chaigne B, Frey C, Uhrig C, Martinot M. Respiratory tract outbreak modeling with case definition criteria: A proposal for a standardized clinical approach in nursing homes. Infect Dis Now 2022; 52:365-370. [DOI: 10.1016/j.idnow.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
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33
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Antibiotic postprescribing modification opportunities among nursing home residents treated for urinary tract infection. Infect Control Hosp Epidemiol 2022:1-6. [DOI: 10.1017/ice.2022.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
Objective:
To characterize opportunities to postprescriptively modify antibiotic prescriptions initiated for treatment of suspected urinary tract infection (UTI) in nursing homes.
Design:
Cross-sectional cohort study.
Methods:
Data from the health records of residents treated for UTI between 2013 and 2014 in 5 Wisconsin nursing homes were abstracted using a structured approach. Explicit definitions were used to identify whether the prescribed antibiotic could have been stopped, shortened, or changed to a nonfluoroquinolone alternative. Antibiotic treatments appropriately modified by study nursing home providers in real time were not considered modifiable. Identification of >1 potential modification opportunity (eg, stop and shorten) per antibiotic treatment event was permitted.
Results:
In total, 356 eligible antibiotic treatment courses among 249 unique residents were identified. Only 59 antibiotic courses prescribed for treatment of suspected UTI (16.6%) were not amenable to any modification. Discontinuation of treatment due to lack of signs or symptoms of infection was the most frequently identified potential modification opportunity (66.2%). Although less common, substantial numbers of antibiotic treatment courses were potentially amenable to shortening (34%) or agent change (19%) modifications. If applied in concert at 72 hours after antibiotic initiation, stop and shorten modifications could eradicate up to 1,326 avoidable antibiotic days, and change modifications could remove a 32 remaining avoidable fluoroquinolone days.
Conclusions:
Substantial opportunity exists to enhance the quality of antibiotic prescribing for treatment of suspected UTI in nursing homes through postprescriptive review interventions. Additional studies examining how to best design and implement postprescriptive review interventions in nursing homes are needed.
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34
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Sansone GR, Bravo E. Novel Care Bundle of Established Basic and Practical Approaches Greatly Reduces Urinary Tract Infections in Nursing Facility Residents without Indwelling Catheters. Am J Infect Control 2022; 51:699-704. [PMID: 36007669 DOI: 10.1016/j.ajic.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Residents in nursing facilities (NFs) are at greater risk of developing urinary tract infections (UTIs) with higher hospitalizations and costs than people living in communities. These residents also have increased likelihood of uroseptic shock and death. The objective of the study was to prevent UTIs and to reduce UTI-associated costs among NF residents. METHODS Quality assurance performance improvement initiative conducted between 4-01-2018 and 3-31-2022 at a large skilled NF. Participants were 262 residents newly diagnosed with UTIs without indwelling catheters. The initiative consisted of: a) a 12-month baseline; b) a 12-month intervention; and c) a 24-month follow-up. A novel care bundle which included staff's hand hygiene monitoring, residents' hydration status, effective incontinence and perineal care, and in-house UTI treatment was implemented during the intervention. The plan-do-study-act cycle was used to gauge its effectiveness. RESULTS Quarterly UTI rates decreased from 4.2% at baseline to 0.9% at follow-up, a 79% reduction (P<0.001). All 262 residents were treated in-house with no UTI-related hospitalizations. Antibiotic prescriptions fell from 373 at baseline down to 143 at follow-up, a 62% reduction. Facility costs decreased from $42,188 at baseline to $8,281 at follow-up (P<0.001). CONCLUSION This bundle was very effective in preventing UTIs and reducing UTI-associated costs. Its use in other NFs is encouraged to determine suitability elsewhere.
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Affiliation(s)
- Giorgio R Sansone
- Office of Healthcare Improvement, Medical and Professional Affairs, New York City Health and Hospitals, New York, NY.
| | - Emalyn Bravo
- Gouverneur Health, New York City Health and Hospitals, New York, NY
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35
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Lim Fat GJ, Gopaul A, Pananos AD, Taabazuing MM. Healthcare-Associated Adverse Events in Alternate Level of Care Patients Awaiting Long-Term Care in Hospital. Geriatrics (Basel) 2022; 7:geriatrics7040081. [PMID: 36005257 PMCID: PMC9407811 DOI: 10.3390/geriatrics7040081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A growing number of Canadian older adults are designated alternate level of care (ALC) and await placement into long-term care (LTC) while admitted to hospital. This creates infrastructural challenges by using resources allocated for acute care during disproportionately long hospital stays. For ALC patients, hospital environments maladapted to their needs impart risk of healthcare-associated adverse events. METHODS In this retrospective descriptive study, we examined healthcare-associated adverse events in 156 ALC patients, 65 years old and older, awaiting long-term care while admitted to two hospitals in London, Ontario in 2015-2018. We recorded incidence of infections and antimicrobial days prescribed. We recorded incidence of non-infectious adverse events including delirium, falls, venothrombotic events, and pressure ulcers. We used a restricted cubic spline model to characterize adverse events as a function of length of stay. RESULTS Patients waited an average of 56 ALC days (ranging from 6 to 333 days) before LTC placement, with seven deaths occurring prior to placement. We recorded 362 total adverse events accrued over 8668 ALC days: 94 infections and 268 non-infectious adverse events. The most common hospital-acquired infections were urinary-tract infections and respiratory infections. The most common non-infectious adverse events were delirium and falls. A total of 620 antimicrobial days were prescribed for infections. CONCLUSIONS ALC patients incur a meaningful and predictable number of adverse events during their stay in acute care. The incidence of these adverse events should be used to educate stakeholders on risks of ALC stay and to advocate for strategies to minimize ALC days.
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Affiliation(s)
- Guillaume J. Lim Fat
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine, Western University, London, ON N6A 3K7, Canada
- Division of Geriatric Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence:
| | - Aquila Gopaul
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine, Western University, London, ON N6A 3K7, Canada
| | - A. Demetri Pananos
- Department of Epidemiology and Biostatistics, Western University, London, ON N6A 3K7, Canada
| | - Mary-Margaret Taabazuing
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine, Western University, London, ON N6A 3K7, Canada
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Jordano Q. A vueltas con la bacteriuria. Med Clin (Barc) 2022; 159:437-439. [DOI: 10.1016/j.medcli.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
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Hall J, Hawkins O, Montgomery A, Singh S, Mullan J, Degeling C. Dismantling antibiotic infrastructures in residential aged care: The invisible work of antimicrobial stewardship (AMS). Soc Sci Med 2022; 305:115094. [PMID: 35690033 DOI: 10.1016/j.socscimed.2022.115094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
Recent social science scholarship has sought to understand the visible and invisible impacts of how antibiotics are entrenched as infrastructures and put to work as a proxy for higher levels of care (clinical or otherwise) within modern healthcare. Using a qualitative research design, in this paper our aim is to draw attention to less visible aspects of antimicrobial stewardship (AMS) in residential aged care and their implications for nurse-led optimization of antibiotic use in these settings. By developing an account of the perceptions, experiences and practices of staff regarding the 'on the ground' work associated with implementing and upholding AMS objectives our study extends research on attempts to dismantle antibiotic infrastructures in Australian residential aged care facilities (RACF). Drawing on a review of relevant policies, empirical data is presented from fifty-six in-depth interviews conducted in 2021 with staff at 8 different RACFs. Interview participants included managers, nurses, and senior and junior personal care assistants. Our results suggest that registered nurses in residential aged care have been tasked with promoting antibiotic optimization and assigned with AMS responsibilities without sufficient authority and resourcing. A host of hidden care work associated with AMS strategies was evident, reinforcing some staff support for empirical antibiotic prescribing as a 'safety net' in uncertain clinical cases. We argue that this hidden work occurs where AMS strategies displace the infrastructural role previously performed by antibiotics, exposing structural gaps and pressures. The inability of organisational accounting systems and the broader AMS policy agenda to capture hidden AMS workflows in RACFs has consequences for future resourcing and organisational learning in ways that mean AMS gaps may remain unaddressed. These results support findings that AMS interventions might not be easily accepted by aged care staff in view of associated burdens which are under recognised and under supported in this domain.
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Affiliation(s)
- Julie Hall
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Olivia Hawkins
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Amy Montgomery
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Saniya Singh
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia; School of Psychology, University of Wollongong, NSW, Australia
| | - Judy Mullan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia; Centre for Health Research Illawarra Shoalhaven Population, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia.
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Delgado KF, Roberson D, Haberstroh A, Wei H. Nursing Staff's Role in Detecting Urinary Tract Infections in Nursing Homes: An Integrative Review. J Gerontol Nurs 2022; 48:43-50. [PMID: 35511064 DOI: 10.3928/00989134-20220405-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite evidence-based protocols, inappropriate antibiotic use still presents a systemic global threat to health care in nursing homes (NHs). Nursing staff are responsible for recognizing signs and symptoms that may indicate urinary tract infections (UTIs). The current integrative review was designed to examine the state of the literature related to the role of nursing staff in UTI identification and care in NHs. This review, which includes 19 articles published between 2011 and 2020, identified that, although prescribers are the experts in UTI management, nursing staff in NHs were the individuals who recognized changes and communicated residents' needs to prescribers. Further research is required to understand nursing staff's decision making and unique perspectives and determine if evidence-based protocols align with current practice in the NH setting. [Journal of Gerontological Nursing, 48(5), 43-50.].
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Hammerschmidt J, Heier L, Ernstmann N. Enablement of nursing home residents in infection prevention during general practitioner visits: A qualitative study. PLoS One 2022; 17:e0266502. [PMID: 35390089 PMCID: PMC8989284 DOI: 10.1371/journal.pone.0266502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hand hygiene measures are essential to protect nursing home residents against nosocomial infections. Evidence on the prevention of nosocomial infections for nursing home residents by general practitioners during their medical visits in nursing homes or how they enable nursing home residents to perform hand hygiene measures is lacking. This study aimed to explore hand hygiene behaviors of general practitioners in nursing homes, their attitudes toward infection prevention measures, and the enablement of nursing home residents in performing hand hygiene measures. MATERIALS AND METHODS Semi-structured interviews were conducted with general practitioners and nursing home residents in Germany. Interviews were audio-recorded and transcribed. Data were analyzed using thematic content analysis. RESULTS Overall, 12 general practitioners and 12 nursing home residents participated in the study. The general practitioners expressed the fact that the possibilities for practicing hand hygiene differ in individual nursing homes. For nursing home residents, the availability of hand rub solutions was limited. Instructions for residents on hand disinfection from general practitioners was not described. Due to the lack of enablement, the residents' knowledge on how to correctly perform hand hygiene was low, although some of the nursing home residents have experience with multidrug-resistant organisms. The nursing home residents varied in their needs for active participation and enablement during the general practitioners visit. CONCLUSION Nursing home residents require continuous enablement by their general practitioners to maintain adequate hand hygiene. Therefore, general practitioners should consider the different needs of nursing home residents to ensure adequate individual hand hygiene and safety for the residents. Existing guidelines for infection prevention and control do not adequately cover the nursing home care setting for the enablement of residents to enquire about hand hygiene.
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Affiliation(s)
| | - Lina Heier
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
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Odagiri T, Maeda I, Masanori Mori, Morita T, Kaneishi K, Junko Nozato, Kazuhiro Kosugi, Higashibata T, Hamano J, Shimoinaba J, Nishi T, Kawashima N. Title: Effects of Antibiotics on Respiratory Symptoms in Terminally Ill Cancer Patients With Pneumonia: A Multicenter Cohort Study. Am J Hosp Palliat Care 2022; 39:1082-1089. [PMID: 35341338 DOI: 10.1177/10499091211058156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Patients in the terminal stages of cancer are frequently affected by infection, especially pneumonia; but the effects of antibiotics on respiratory symptoms and factors associated with improvement are still unclear. OBJECTIVES This study aimed to clarify the effects of antibiotics on respiratory symptoms of terminally ill cancer patients with pneumonia, and to explore factors associated with the improvement. METHODS This was a prospective cohort study in which we consecutively recruited terminally ill cancer patients diagnosed with pneumonia and treated with antibiotics at one of 23 palliative care units across Japan. At the baseline and Day 3, primarily responsible palliative care specialists recorded patient backgrounds, the results of physical and laboratory examination, and patient symptoms using the Support Team Assessment Schedule. Improvement was defined as improvement of dyspnea, cough, and sputum production on Day 3. RESULTS Among all 1896 patients admitted during the study periods, 137 patients (7.2%) were enrolled into this study. Improvement was achieved in 65 patients (47.4%; 95% confidence intervals, 39-56). Univariate analyses revealed that the Palliative Prognostic Index (PPI), respiratory rate (RR), and oxygen requirement were significantly associated with the improvement. A multiple logistic regression analysis identified that PPI score of ≤ 6 and RR of <20 were independently associated with the improvement (odds ratios, 4.4 [1.6-12] and 2.5 [1.1-5.5], respectively). CONCLUSION Antibiotics may relieve respiratory symptoms from pneumonia in approximately half of the terminally ill cancer patients. PPI and respiratory rate are useful to identify the patients who received benefits of antibiotics.
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Affiliation(s)
- Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara Genral Hospital, Hamamatsu, Japan
| | - Keisuke Kaneishi
- Department of Palliative Internal Medicine, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Junko Nozato
- Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, 26351National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Higashibata
- Palliative Care Team, Department of General Medicine and Primary Care, 68320University of Tsukuba Hospital, Tsukuba, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Tomohiro Nishi
- Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center, Kawasaki, Japan
| | - Natsuki Kawashima
- Department of Palliative Medicine, 26420Tsukuba Medical Center Hospital, Tsukuba, Japan
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Latour K, De Lepeleire J, Catry B, Buntinx F. Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study. BMC Geriatr 2022; 22:187. [PMID: 35255822 PMCID: PMC8903673 DOI: 10.1186/s12877-022-02866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Urinary tract infections (UTIs) are one of the most common infections in nursing homes (NHs). A high error rate of a UTI diagnosis based solely on clinical criteria is to be expected in older persons as they often present infections in an atypical way. A study was set up to assess the diagnostic value of signs/symptoms and urine dipstick testing in identifying UTIs in NH residents and to explore whether C-reactive protein (CRP) measured by point-of-care testing (POCT) can help in the diagnosis. Methods During a three month prospective multicentre study, urine sampling for culture, POCT CRP and urinary dipstick testing were performed in each NH resident with a suspected UTI. UTIs were defined according to Stone et al., i.e. criteria based upon the presence of a set of signs/symptoms and a positive urine culture. Results Eleven NHs and 1 263 residents participated. Sixteen out of 137 recorded UTI suspicions were confirmed. Acute dysuria (positive likelihood ratio (LR +): 7.56, 95% confidence interval (CI): 3.94–14.5) and acute suprapubic pain (LR + : 11.4, 95% CI: 3.58–35.9) were found to be significant predictors. The combined nitrite and leucocyte esterase urine dipstick test (one or both positive) had a 96.0% negative predictive value (95% CI: 80.5–99.3%). The sensitivity of a positive CRP test (≥ 5 mg/L) was 60.0% (95% CI: 32.3–83.7%). Antimicrobials were prescribed in 60.2% of suspected but unconfirmed UTIs and in 92.3% of confirmed UTIs. Conclusions Using a stringent definition, only 11.7% of our suspicions were confirmed. Besides acute dysuria and suprapubic pain, we were not able to prove that any other clinical sign/symptom or POCT CPR adds useful information to the UTI diagnosis. We confirmed the findings of earlier research that urine dipstick tests are useful in ruling out UTIs and identified a potential overuse of antimicrobials in our NH population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02866-2.
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Affiliation(s)
- Katrien Latour
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Boudewijn Catry
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank Buntinx
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of General Practice, Maastricht University, Maastricht, The Netherlands
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42
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Latour K, Catry B, Devleesschauwer B, Buntinx F, De Lepeleire J, Jans B. Healthcare-associated infections and antimicrobial use in Belgian nursing homes: results of three point prevalence surveys between 2010 and 2016. Arch Public Health 2022; 80:58. [PMID: 35180883 PMCID: PMC8855602 DOI: 10.1186/s13690-022-00818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Belgium monitors the burden of healthcare-associated infections (HAIs) and antimicrobial use in nursing homes (NHs) by participating in the European point prevalence surveys (PPSs) organised in long-term care facilities (HALT surveys). We present the main findings of the three national PPSs conducted in NHs participating in at least one of these surveys, and in a cohort that participated in all three consecutive surveys. Methods All NHs were invited to voluntarily participate and conduct the survey on one single day in May-September 2010 (HALT-1), in April-May 2013 (HALT-2) or in September-November 2016 (HALT-3). Data were collected at institutional, ward and resident level. A detailed questionnaire had to be completed for all eligible (i.e. living full time in the facility since at least 24 h, present at 8:00 am and willing to participate) residents receiving at least one systemic antimicrobial agent and/or presenting at least one active HAI on the PPS day. The onset of signs/symptoms had to occur more than 48 h after the resident was (re-)admitted to the NH. Results A total of 107, 87 and 158 NHs conducted the HALT-1, HALT-2 and HALT-3 survey, respectively. The median prevalence of residents with antimicrobial agent(s) increased from 4.3% (95% confidence interval (CI): 3.5-4.8%) in HALT-1 to 4.7% (95% CI: 3.5-6.5%) in HALT-2 and 5.0% (95% CI: 4.2-5.9%) in HALT-3. The median prevalence of residents with HAI(s) varied from 1.8% (95% CI: 1.4-2.7%) in HALT-1 to 3.2% (95% CI: 2.2-4.2%) in HALT-2 and 2.7% (95% CI: 2.1-3.4%) in HALT-3. Our post-hoc analysis on the cohort (n = 25 NHs) found similar trends. In all three surveys, respiratory tract infections were most frequently reported, followed by skin/wound infections in HALT-1 and urinary tract infections in HALT-2 and HALT-3. Antimicrobials were most commonly prescribed for the therapeutic treatment of an infection: 66.4% in HALT-1, 60.9% in HALT-2 and 64.1% in HALT-3. Uroprophylaxis accounted for 28.7%, 35.6% and 28.4% of all prescriptions, respectively. Conclusions None withstanding the limitations peculiar to the study design, the PPSs enabled us to assess the occurrence of and to increase awareness for HAIs and rational antimicrobial use in NHs at both local and national level. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00818-1.
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Affiliation(s)
- Katrien Latour
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Boudewijn Catry
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Frank Buntinx
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Béatrice Jans
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Kistler CE, Wretman CJ, Zimmerman S, Enyioha C, Ward K, Farel CE, Sloane PD, Boynton MH, Beeber AS, Preisser JS. Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline. J Am Geriatr Soc 2022; 70:1070-1081. [PMID: 35014024 DOI: 10.1111/jgs.17638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE To inform overprescribing and antibiotic stewardship in nursing homes (NHs), we examined the concordance between clinicians' (NH primary care providers and registered nurses) diagnosis of suspected UTI with a clinical guideline treated as the gold standard, and whether clinician characteristics were associated with diagnostic classification. METHODS We conducted a cross-sectional web-based survey of a U.S. national convenience sample of NH clinicians. The survey included a discrete choice experiment with 19 randomly selected clinical scenarios of NH residents with possible UTIs. For each scenario, participants were asked if they thought a UTI was likely. Responses were compared to the guideline to determine the sensitivity and specificity of clinician judgment and performance indicators. Multivariable logistic mixed effects regression analysis of demographic, work, personality, and UTI knowledge/attitudes characteristics was conducted. RESULTS One thousand seven hundred forty-eight NH clinicians responded to 33,212 discrete choice scenarios; 867 (50%) were NH primary care providers and 881 (50%) were NH registered nurses, 39% were male, and the mean age was 45 years. Participants were uncertain about diagnosis in 30% of scenarios. Correct classification occurred for 66% of all scenarios (providers: 70%; nurses: 62%). Respondent judgment had a sensitivity of 78% (providers: 81%; nurses: 74%) and specificity of 54% (providers: 59%; nurses: 49%) compared to the clinical guideline. Adjusting for covariates in multivariable models, being a nurse and having higher closemindedness were associated higher odds of false positive UTI (odds ratio [OR] 1.61, p < 0.001; and OR 1.09, p = 0.039, respectively), although higher UTI knowledge and conscientiousness were associated with lower odds of false positive UTI ratings (OR 0.80, p < 0.001; OR 0.90, p = 0.005, respectively). CONCLUSIONS Clinicians tend to over-diagnose urinary tract infections, necessitating systems-based interventions to augment clinical decision-making. Clinician type, UTI knowledge, and personality traits may also influence behavior and deserve further study.
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Affiliation(s)
- Christine E Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.,The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher J Wretman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.,School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.,School of Social Work, University of North Carolina, Chapel Hill, NC, USA.,Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Chineme Enyioha
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Kimberly Ward
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Claire E Farel
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Philip D Sloane
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.,The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Marcella H Boynton
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Anna S Beeber
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - John S Preisser
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Harper A, Kepner S. Urinary Tract Infections in Pennsylvania Long-Term Care Facilities. PATIENT SAFETY 2021. [DOI: 10.33940/data/2021.12.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Urinary tract infections (UTIs) are common healthcare-associated infections (HAIs) in older adults that live in long-term care (LTC) facilities. A query of the Pennsylvania Patient Safety Reporting System (PA-PSRS) found that symptomatic UTI (SUTI) and catheter-associated UTI (CAUTI) rates increased from 2016 and peaked in the second quarter of 2020. Although the number of urinary catheter days reported by LTC facilities has trended downward from 2016 to the beginning of 2020, the urinary catheter utilization rate increased slightly in the second quarter of 2020. We also examined various epidemiological factors. An average of 47.6% of SUTIs and 32.3% of CAUTIs were associated with E. coli from 2016 through 2020. However, the percentage of CAUTIs associated with E. coli decreased while the percentage of CAUTIs associated with organisms of the tribe Proteeae (Proteus, Providencia, and Morganella genera) increased from 2016 through 2020. Furthermore, the percentage of CAUTIs associated with carbapenem-resistant Enterobacterales (CRE) and organisms producing extended-spectrum beta-lactamases (ESBL) also increased, while the percentage of CAUTIs associated with vancomycin-resistant Enterococci (VRE) decreased from 2016 through 2020. An average of 38.5% of SUTIs and 41.5% of CAUTIs were reported to be treated with fluoroquinolones from 2016 through 2020. However, the percentage of both SUTIs and CAUTIs treated with fluoroquinolones decreased from 2016 through 2020, while an increasing percentage of both SUTIs and CAUTIs was reported to have been treated with cephalosporins and carbapenems from 2016 through 2020. Thus, to further promote resident safety, we use these epidemiological trends to better understand current risks for residents and to further guide development of best practices for prevention, identification, and treatment of UTIs as well as to further advance antibiotic stewardship practices.
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Pitkäpaasi M, Lehtinen JM, Kanerva M. Point prevalence survey is useful for introducing effective surveillance of healthcare-associated infections. Infect Prev Pract 2021; 3:100182. [PMID: 34877524 PMCID: PMC8627978 DOI: 10.1016/j.infpip.2021.100182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/03/2021] [Indexed: 10/24/2022] Open
Abstract
Background In Finland, the surveillance of healthcare-associated infections (HAI) became obligatory by the renewed Communicable Diseases Act on the 1st March 2017. Aim To introduce HAI surveillance protocol (HALT-2 by ECDC) in primary care hospitals in the largest hospital district in Finland, and to measure the burden of HAIs and antimicrobial use patterns for improvement. Methods Two identical point prevalence surveys (PPS) were organized in autumn 2015 and in spring 2017. The infection control persons (ICP) in the hospitals were inducted to the HAI definitions and the study protocol to collect the data with questionnaires on the study days. The data were checked and analyzed by the areal infection control unit. The hospitals were provided feedback of the results and HAI prevention methods. Findings In 2015, 2218 patients from 22 hospitals and in 2017, 2343 patients from 25 hospitals were studied. The prevalence of HAI was 11% in both surveys (ranges per hospital 4-24% and 4-31%, respectively). Of all HAIs, 37% originated from referring hospitals. Respiratory tract, urinary tract and skin were the most frequent sites of infection. One fourth of all patients received at least one systemic antimicrobial. The process showed that recognition of HAIs may be difficult for non-experienced ICPs. Conclusions The HALT-2 protocol proved useful in introducing HAI surveillance and prevention in primary care hospitals with active patient transfer from other hospitals and relatively high prevalence of HAI and antimicrobial use. For annually repeated surveys, slightly shorter electronic questionnaires are essential.
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Affiliation(s)
- Marjaana Pitkäpaasi
- Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland.,Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jaana-Marija Lehtinen
- Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Mari Kanerva
- Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland
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Adawee M, Cole S. Establishing an evidence-based infection surveillance program for home care and hospice: A large Midwest health system's experience. Am J Infect Control 2021; 49:1551-1553. [PMID: 34400245 DOI: 10.1016/j.ajic.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
Home care and hospice are unique and rapidly growing healthcare settings. However, there is a lack of published findings related to evidence-based infection surveillance programs among these settings. Our health system hired a Home Care and Hospice Infection Preventionist to implement an infection surveillance program using evidence-based infection surveillance criteria appropriate for these settings, the Association for Professionals in Infection Control and Epidemiology (APIC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) definitions for home health care and home hospice infections, National Healthcare Safety Network long-term care facility (LTCF) criteria, and McGeer criteria for LTCFs. These surveillance criteria were built into new surveillance databases for Home Care, Home Hospice, and inpatient Hospice House. Infection Prevention reported infections and trends to respective departments monthly and as needed in the event of any significant infections. For most infection types, there were less infections identified during January-April 2021 than for the same period in 2019-2020. Having Infection Prevention coordinate the Home Care and Hospice infection surveillance program will help establish reliable healthcare-associated infection baseline data and help identify the population at risk. Future enhancements to automatically identify infections among this patient population are planned once Home Care and Hospice begin using the health system's electronic medical record.
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Affiliation(s)
- Mohamed Adawee
- Department of Infection Prevention and Epidemiology, Sparrow Health System, Lansing, MI.
| | - Stefanie Cole
- Department of Infection Prevention and Epidemiology, Sparrow Health System, Lansing, MI
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Pinnell RAM, Ramsay T, Wang H, Joo P. Urinary Tract Infection Investigation and Treatment in Older Adults Presenting to the Emergency Department with Confusion: a Health Record Review of Local Practice Patterns. Can Geriatr J 2021; 24:341-350. [PMID: 34912489 PMCID: PMC8629500 DOI: 10.5770/cgj.24.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The rate of urinary tract infection (UTI) investigation and treatment in confused older emergency department (ED) patients has not been described in the literature. We aim to describe the pattern of practice in an academic tertiary care ED for this common presentation. METHODS A health record review was conducted on 499 adults aged ≥65 presenting to academic EDs with confusion. Exclusion criteria: Glasgow Coma Scale < 13, current treatment for UTI, indwelling catheters, nephrostomy tubes, transfer from another hospital. Outcomes were the prevalence of UTI investigation, diagnosis and antibiotic treatment. RESULTS 64.9% received urine tests, 11.4% were diagnosed with UTI, and 35.2% were prescribed antibiotics. In the subgroup with no urinary symptoms, fever, or other obvious indication for antibiotics, these numbers were 58.2%, 7.6%, and 18.1%, respectively. Patients who had urine tests or received antibiotics were older than those who did not (p values < .01). Patients receiving antibiotics had higher admission rates and 30-day and six-month mortality (OR of 2.9 [2.0-4.3], 4.0 [1.6-11], and 2.8 [1.4-5.8], respectively). CONCLUSION Older patients presenting to ED with confusion were frequently investigated and treated for UTI, even in the absence of urinary symptoms. Antibiotic treatment was associated with higher hospitalization and mortality.
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Affiliation(s)
| | - Tim Ramsay
- Ottawa Hospital Research, Institute, Ottawa, ON
| | - Han Wang
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pil Joo
- Ottawa Hospital Research, Institute, Ottawa, ON
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
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Lehnertz NB, Lifson A, Galloway E, Taylor J, Carter RJ, Kazazian L, Day K, Miller S, Mendez E, Lynfield R. Temperature and oxygen saturation in skilled nursing facility residents positive for SARS-CoV-2 prior to symptom onset. J Am Geriatr Soc 2021; 70:363-369. [PMID: 34751428 DOI: 10.1111/jgs.17567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spreads rapidly amongst residents of skilled nursing facilities (SNFs). The rapid transmission dynamics and high morbidity and mortality that occur in SNFs emphasize the need for early detection of cases. We hypothesized that residents of SNFs infected with SARS-CoV-2 would demonstrate an acute change in either temperature or oxygen saturation (SpO2 ) prior to symptom onset. The Minnesota Department of Health (MDH) conducted a retrospective analysis of both temperature and SpO2 at two separate SNFs to assess the utility of these quantitative markers to identify SARS-CoV-2 infection prior to the development of symptoms. METHODS A retrospective analysis was conducted of 165 individuals positive for SARS-CoV-2 who were residents of SNFs that experienced coronavirus disease 2019 (COVID-19) outbreaks during April-June 2020 in a metropolitan area of Minnesota. Age, sex, symptomology, temperature and SpO2 values, date of symptom onset, and date of positive SARS-CoV-2 test were analyzed. Temperature and SpO2 values for the period 14 days before and after the date of initial positive test were included. Descriptive analyses evaluated changes in temperature and SpO2 , defined as either exceeding a set threshold or demonstrating an acute change between consecutive measurements. RESULTS Two (1%) residents had a temperature value ≥100°F, and 30 (18%) had at least one value ≥99°F within 14 days before symptom development. One hundred and sixteen residents (70%) had at least one SpO2 value ≤94%, while 131 (80%) had an acute decrease in SpO2 of ≥3% between consecutive values in the 14 days prior to symptom onset. CONCLUSIONS Our results suggest that acute change in SpO2 might be useful in the identification of SARS-CoV-2 infection prior to the development of symptoms among residents living in SNFs. Facilities may consider adding SpO2 to daily temperature and symptom screening checklists to improve early detection of residents of SNFs infected with SARS-CoV-2.
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Affiliation(s)
- Nicholas B Lehnertz
- Division of Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Alan Lifson
- Division of Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Eboni Galloway
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joanne Taylor
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Lilit Kazazian
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katelyn Day
- Division of Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Sarah Miller
- Division of Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Elyssa Mendez
- Division of Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Ruth Lynfield
- Division of Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, St. Paul, Minnesota, USA
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Cooper DL, Buterakos R, Wagner LM, Tith J, Lee SYD. A retrospective comparison of guidelines to assess hospital-diagnosed urinary tract infection in nursing home residents. Am J Infect Control 2021; 49:1354-1358. [PMID: 33872686 DOI: 10.1016/j.ajic.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Inappropriate antibiotic treatments for urinary tract infection (UTI) in nursing home (NH) residents are common and contribute to antibiotic resistance. Published guidelines aim to improve accurate assessment, diagnosis, and treatment of UTIs. This study assessed whether records from hospitalized NH residents diagnosed with UTI, while comparing the Cooper Tool and Stone criteria, supported appropriate treatment. METHODS A retrospective chart review was conducted using electronic medical record (EMR) data from residents of 3 NHs who were diagnosed with UTI when hospitalized over a 3-year period. The Cooper Tool and Stone criteria were used to assess treatment appropriateness. RESULTS Of 79 hospitalized residents treated for UTI, 11 (13.9%) were appropriately treated according to the Cooper Tool and 9 (11.4%) according to Stone. The 2 criteria agreed in 9 of the cases including 100% of those with catheters. Urinalysis was documented in 72% of residents and 24% had documentation of culture and sensitivity. CONCLUSIONS Appropriate UTI treatment rates using both tools were low but much higher in those with catheters. Future research is necessary to validate the use of these tools in the hospital setting which have the potential to improve treatment accuracy and reduce unnecessary antibiotics use.
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Kuil SD, van Leth F, Schneeberger C, de Jong MD, Harting J. Clinical Reasoning Underlying Guideline Nonadherence in Urinary Tract Infections in Nursing Homes. J Am Med Dir Assoc 2021; 23:896-898. [PMID: 34687606 DOI: 10.1016/j.jamda.2021.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sacha Daniëlle Kuil
- Department of Medical Microbiology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank van Leth
- Department of Health Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Caroline Schneeberger
- Department of Medical Microbiology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno Douwe de Jong
- Department of Medical Microbiology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Janneke Harting
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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