HARRISBURG, Pa: The improper use of antibiotics in long-term care facilities (LTCFs), specifically for the treatment of urinary tract infections (UTIs), can increase the risk of resident harm and contribute to the rapid emergence of antibiotic-resistant bacteria.
"Antibiotic-resistant organisms are not only a threat to the health of patients and residents, they're threat to everyone," said Dr. Ellen S. Deutsch, medical director for the Pennsylvania Patient Safety Authority. "Antibiotics have saved the lives of millions of people, and now their effectiveness is under assault," said Deutsch. "The misdiagnosis of UTIs in LTCFs, which leads to the misuse and overuse of antibiotics, contributes to antimicrobial-resistance."
Antibiotics are the most commonly prescribed medication in LTCFs; however, they are prescribed incorrectly up to 75% of the time, according to national statistics. UTIs represent the most common bacterial infection in LTCFs, and due to the frequency of their misdiagnosis, largely contribute to the overuse and misuse of antibiotics.
From April 2014 through September 2016, Pennsylvania LTCFs reported 13,680 UTIs to the Authority. In examining antibiotic prescribing practices, Authority analysts found deviance from national practice guidelines for treating UTIs and suboptimal use of antibiotics.
Common misperceptions may result in inappropriate treatment, overuse of broad-spectrum antibiotics, and failure to review or change antibiotics following laboratory test results.
"Antibiotic resistance and other complications are a significant problem, and defeating this problem will take widespread and sustained effort," said Deutsch. "The appropriate management of UTIs and possible UTIs is an important piece of this large puzzle."
In the Authority's September 2017 Pennsylvania Patient Safety Advisory article, "Optimal Use of Antibiotics for Urinary Tract Infections in Long-Term Care Facilities: Successful Strategies Prevent Resident Harm," the Authority provides a comprehensive list of risk reduction strategies. Accompanying the article is the "Living Branches Urinary Tract Infection (UTI) Evaluation Guideline," a UTI evaluation tool adapted from the Pennsylvania Medical Directors Association (PMDA). Utilization of both the risk reduction strategies and the UTI evaluation tool may help facilities properly manage UTIs and implement a solid antimicrobial stewardship plan.
