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The purpose of this study was to determine if a multi-faceted intervention to implement diagnostic and therapeutic algorithms for management of suspected urinary infection in nursing home residents could reduce antibiotic prescribing for urinary indications in this population.
Condition or disease
Urinary Tract Infection, Antibiotic Use
Behavioral: diagnostic and treatment clinical algorithms
Antibiotic use is intense in nursing homes and frequently inappropriate when prescribed for urinary indications. Evidence from randomized controlled trials suggests that treatment of asymptomatic bacteriuria, the presence of bacteria in the urine in the absence of urinary symptoms, is not beneficial. Despite this, one in three prescriptions for urinary indications are for asymptomatic bacteriuria. To improve antibiotic prescribing in this setting we conducted a cluster randomized trial of a strategy to implement diagnostic and treatment algorithms for urinary infection. 24 nursing homes were randomized to either the intervention (implemented at the nursing home level using a multi-faceted approach: small group interactive sessions for nurses, one-on-one interviews for physicians, videotapes, written material, and outreach visits) or to usual care.
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Ages Eligible for Study:
Child, Adult, Older Adult
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Individuals- all residents eligible
Free standing long term care facilities with >100 beds
No stated policy for diagnosis or treatment of urinary tract infections
The facility agrees to refrain from introducing new strategies for antibiotic utilization or clinical pathways during study