Kevin Antoine Brown1,2,3, Nick Daneman1,2,4,5, Kevin L Schwartz1,2,3,6, Bradley Langford1, Allison McGeer3,7, Jacquelyn Quirk1, Christina Diong2, Gary Garber1,8. 1. Public Health Ontario, Canada. 2. Institute for Clinical Evaluative Sciences, Canada. 3. Dalla Lana School of Public Health, University of Toronto, Canada. 4. Sunnybrook Research Institute, Division of Infectious Diseases, Canada. 5. The Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. 6. St Joseph's Health Centre, Canada. 7. Mount Sinai Hospital, Toronto, Canada. 8. Ottawa Research Institute, Canada.
Abstract
BACKGROUND: Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. METHODS: We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering >90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. RESULTS: A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18-1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28-1.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07-1.31). CONCLUSIONS: Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection. Her Majesty the Queen in Right of Canada, as represented by the Public Health Ontario, 2019.
BACKGROUND: Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. METHODS: We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering >90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. RESULTS: A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18-1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28-1.38), and C. difficileinfection (incidence rate ratio, 1.18; 95% CI, 1.07-1.31). CONCLUSIONS: Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficileinfection. Her Majesty the Queen in Right of Canada, as represented by the Public Health Ontario, 2019.
Entities:
Keywords:
zzm321990 Clostridium difficile infection (CDI); antibiotic stewardship; long-term care; urine culture; variation in care
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Authors: Andrea Chambers; Cynthia Chen; Kevin Antoine Brown; Nick Daneman; Bradley Langford; Valerie Leung; Kwaku Adomako; Kevin L Schwartz; Julia E Moore; Jacquelyn Quirk; Sam MacFarlane; Tim Cronsberry; Gary E Garber Journal: BMJ Qual Saf Date: 2021-04-14 Impact factor: 7.035