Prospective evaluation of the management of urinary tract infections in 134 French nursing homes

• Published in: Médecine et maladies infectieuses 2018-08, Vol.48 (5), p.359-364
• Main Authors: Lemoine, L., Dupont, C., Capron, A., Cerf, E., Yilmaz, M., Verloop, D., Blanckaert, K., Senneville, E., Alfandari, S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibiotiques; Bacteriuria - diagnosis; Bacteriuria - drug therapy; Diagnostic Errors; Disease Management; EHPAD; Elderly; France - epidemiology; Guideline Adherence; Humans; Inappropriate Prescribing; Infections urinaires; Life Sciences; Male; Nursing Homes; Personnes âgées; Practice Guidelines as Topic; Prospective Studies; Surveys and Questionnaires; Urinary tract infections; Urinary Tract Infections - diagnosis; Urinary Tract Infections - drug therapy; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology
• ISSN: 0399-077X; 1769-6690; 1769-6690
• DOI: 10.1016/j.medmal.2018.04.387

•This study assessed the management of urinary tract infections in 134 nursing homes.•Each nursing home could include up to five consecutive case patients.•Erroneous diagnostic criteria were used in 21% of cases.•First-line antibiotics complied with guidelines in 30% of reclassified diagnoses.•Multiple deficiencies in the diagnosis and management of urinary tract infections were identified which will help define priorities for intervention. Prospective assessment of the management of urinary tract infections (UTI) in the nursing homes of the Hauts-de-France region. A 50-question form had to be filled in for up to five consecutive residents treated for UTI in each nursing home. If necessary, diagnoses were reclassified according to the 2014 French Infectious Diseases Society guidelines. Analyses were presented per supposed (reported) and reclassified diagnoses. Of 397 contacted facilities, 134 participated and informed 444 UTI episodes. Reported diagnostic criteria were burning urination (32%), malodorous urine (29%), confusion (28%), and turbid urine (19%). Twenty-one percent of diagnoses were based on erroneous criteria. Less than 50% of residents had a urine dipstick test performed and 94% a urine culture. The main pathogen was Escherichia coli. Reported indications were uncomplicated cystitis (32%), unspecified UTI (26%), complicated cystitis (9%), while no reason was given in 25% of cases. Only 10% of diagnoses were consistent with the guidelines: complicated cystitis (49%), asymptomatic bacteriuria (21%), acute pyelonephritis (21%), male UTI (9%). Almost 85% of prescriptions were active on the isolated bacteria. The empirical antibiotic therapy was consistent with the diagnosis in 16% of cases (30% for reclassified diagnoses). The two most prescribed antibiotic classes were fluoroquinolones (22.1%) and oral third-generation cephalosporins (19.1%). Only two of 157 possible de-escalations were performed. Duration of treatment was adequate for 19% of UTIs (9.6% of reclassified cases). Our study revealed multiple deficiencies in diagnosis, antibiotic choice, treatment duration, and reevaluation. Évaluation prospective de la prise en charge des infections urinaires (IU) dans les établissements d’hébergement pour personnes âgées dépendantes des Hauts-de-France. Questionnaire (50 questions) pour cinq cas consécutifs d’IU maximum par établissement. Les diagnostics rapportés ont, si besoin, été corrigés selon les recommandations de la SPILF. Les résultats sont