Attacking Inappropriate Antibiotic Use for Asymptomatic Bacteriuria in Long Term Care through a Comprehensive UTI Prevention Protocol: A 2 Year Report

Background: In long term care (LTC), UTI’s are considered one of the most common infections treated. Also highly prevalent in LTC is asymptomatic bacteriuria (ASB), which mirrors a UTI with a positive culture, but lacks specific symptoms arising from the urinary tract (dysuria, frequency, flank pain etc.). ASB does NOT benefit from antibiotic (ABX) treatment thus distinguishing between a symptomatic UTI from ASB is imperative to reduce inappropriate ABX use which can lead to increased ABX resistance and transmission of resistant bacteria to other LTC residents (1,2,4,5).

Objective:  The goal of this project was to reduce the number of ASB conditions treated with antibiotics by assisting LTC staff in distinguishing between symptomatic UTI and ASB (3) through implementation of a Comprehensive UTI Prevention Protocol. This project examined the impact of the UTI education and prevention program on (1) antibiotic use for possible UTIs and (2) the number of urine cultures performed.

Review of Literature: The prevalence of ASB:25-50% among women and 15-40% among men in  LTC, much higher than the prevalence in community-dwelling elders.  Although ASB and symptomatic UTI look alike on paper, treatment is not warranted for ASB (1-5)!

Method: The quality improvement project took place in a 200-bed LTC facility. Residents were place on a 3-day UTI prevention protocol if 1-2 vague UTI symptoms were noted. The protocol consisted of monitoring the symptom(s) every shift for 3 days as well as instituting specific nursing interventions. If 3 symptoms occurred at any time during the protocol, the PCP was notified and a catheterized UA and culture were sent.

Results: There was a significant reduction in antibiotic usage.  During the pre-intervention period the median number of antibiotics prescribed in from Jan. 06 to Aug. 07 per month was 7; post-intervention, the median number was 3 from Sept. 07 to May 08.  The median difference in the number of antibiotics prescribed pre and post intervention was 5. There was also a statistically significant reduction in the number of urine cultures performed monthly. Prior to implementation a median of 6 cultures per month was preformed from Jan. 06 to Aug. 07.  This decreased to 3 from Sept. 07 to May 08 following the intervention.  Complete results for a 2-year period post-intervention will be forthcoming.