NH Staff Intervention Reduces Antibiotic Overprescribing for UTIs

An intervention aimed at improving knowledge about urinary tract infections (UTIs) and communication among nursing home (NH) staff reduced overtreatment with antibiotics without a significant impact on hospitalizations or mortality, new research published in The Lancet Infectious Diseases shows.

The open label, parallel group, cluster randomized controlled trial included 1625 residents across 22 NHs in Denmark. Residents were aged 65 years or older and lived in spaces “designated for those with dementia or somatic health care needs.”

Between June 2017 and June 2018, 11 randomized NHs received a dialogue tool and interactive educational sessions about UTIs, while the other 11 did not. The intervention involved 75-minute sessions over 8 weeks, where staff learned distinctions between UTIs and asymptomatic bacteriuria, as well as how to evaluate nonspecific symptoms.

Researchers analyzed 765 residents in the intervention group and 705 in the control group. Significant findings included the following:

• The number of antibiotic prescriptions for UTI per resident was 134 per 84,035 days at risk in the intervention group and 228 per 77,817 days at risk in the control group.
• The rate ratio of receiving an antibiotic for UTI was 0.51 (95% CI 0.37-0.71) in the unadjusted model and 0.42 (0.31-0.57) in the adjusted model. 
• The risk of all-cause hospitalization increased in the intervention group (adjusted model RR 1.28, 95% CI 0.95-1.74), whereas all-cause mortality was lower in the intervention group (0.91, 0.62-1.33).

There were no deaths reported in the 140 entries of suspected UTIs.

“The intervention effectively reduced antibiotic prescriptions and inappropriate treatments for UTI without substantially influencing all-cause hospitalizations and mortality,” study authors concluded.

Reference:
Arnold SH, Jensen JN, Bjerrum L, et al. Effectiveness of a tailored intervention to reduce antibiotics for urinary tract infections in nursing home residents: a cluster, randomized controlled trial [published online ahead of print July 22, 2021]. Lancet Infect Dis. 2021;S1473-3099(21)00001-3. doi:10.1016/S1473-3099(21)00001-3