 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Therese M. Martaus, MPH and Mary Jane Lambert, MD. Skilled Nursing Facility Clinical Services, Group Health Cooperative, 125 16th Avenue East, CEB - 301, Seattle, WA 98112
Urinary Tract Infection (UTI) is a common problem in the Long Term Care (LTC) and Skilled Nursing Facility (SNF) settings. An estimated 16 to 24% of persons in nursing facility settings will receive treatment for UTI in a year. Yet, the literature suggests UTI is an over-diagnosed and over-treated condition and that repeated treatment may be contributing to the emergence of resistant organisms such as MRSA and VRE and to the increased incidence of C. diff. colitis infection. Focusing on the CDC strategy to prevent antimicrobial resistance for those persons considered at highest risk for inappropriate antibiotic use, including nursing home residents, we undertook a study to evaluate our clinical management and to reduce variability in treatment of urinary tract infections. We used three approaches: literature review for evidence based practice regarding diagnosis and treatment of urinary symptoms and urinary tract infection; chart review of our patients with urinalysis test orders; and clinician interview results using case studies. Consultation review was obtained from Urology and Infectious Disease specialists. Findings from the literature included no evidence based standards for management of UTI in the geriatric institutional population. Chart review and case study analysis demonstrated that as individual clinicians our practice varied, including the decision to obtain initial urinalysis and subsequent antibiotic selection, dose, and course of treatment. Sharing results of the study with our practice group resulted in standard criteria for obtaining initial urinalysis testing and a narrowing of selection of first line antibiotic treatment. Further studies are proposed to develop evidence based standards for management of urinary tract infection in this vulnerable population.
Learning Objectives:
Keywords: Elderly, Practice Guidelines
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.