Optimizing Antibiotic Use in Long Term Care

Not Applicable

Completed

• Conditions: Urinary Tract Infection, Antibiotic Use

• Registration Number: NCT00243360
• Lead Sponsor: Agency for Healthcare Research and Quality (AHRQ)

Brief Summary

The purpose of this study was to determine if a multi-faceted intervention to implement diagnostic and therapeutic algorithms for management of suspected urinary infection in nursing home residents could reduce antibiotic prescribing for urinary indications in this population.

Detailed Description

Antibiotic use is intense in nursing homes and frequently inappropriate when prescribed for urinary indications. Evidence from randomized controlled trials suggests that treatment of asymptomatic bacteriuria, the presence of bacteria in the urine in the absence of urinary symptoms, is not beneficial. Despite this, one in three prescriptions for urinary indications are for asymptomatic bacteriuria. To improve antibiotic prescribing in this setting we conducted a cluster randomized trial of a strategy to implement diagnostic and treatment algorithms for urinary infection. 24 nursing homes were randomized to either the intervention (implemented at the nursing home level using a multi-faceted approach: small group interactive sessions for nurses, one-on-one interviews for physicians, videotapes, written material, and outreach visits) or to usual care.

Study Timeline

• Study Start: 2001-01
• Study Completion: 2003-07
• Status Verified: 2005-10
• Study First Submitted: 2005-10-21
• Study First Submitted QC: 2005-10-21
• Last Update Submitted: 2005-10-21
• Study First Posted: 2005-10-24
• Last Update Posted: 2005-10-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

1. Individuals- all residents eligible

2. Nursing homes

   • Free standing long term care facilities with >100 beds
   • No stated policy for diagnosis or treatment of urinary tract infections
   • The facility agrees to refrain from introducing new strategies for antibiotic utilization or clinical pathways during study

Exclusion Criteria

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Antimicrobial prescriptions

Secondary Outcome Measures

Name	Time	Method
hospitalizations, deaths
Urinary cultures,

Trial Locations

Locations (1)

McMaster University; 🇨🇦 Hamilton, Ontario, Canada