Predictors of potentially suboptimal treatment of urinary tract infections in long-term care facilities.
Community Living Center
Long-term care facility
Suboptimal antibiotic use
Urinary tract infection
Veterans Affairs
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
04
06
2020
revised:
15
01
2021
accepted:
15
01
2021
pubmed:
8
2
2021
medline:
5
8
2021
entrez:
7
2
2021
Statut:
ppublish
Résumé
Suboptimal antibiotic treatment of urinary tract infection (UTI) is high in long-term care facilities (LTCFs) and likely varies between facilities. Large-scale evaluations have not been conducted. To identify facility-level predictors of potentially suboptimal treatment of UTI in Veterans Affairs (VA) LTCFs and to quantify variation across facilities. This was a retrospective cohort study of 21,938 residents in 120 VA LTCFs (2013-2018) known as Community Living Centers (CLCs). Potentially suboptimal treatment was assessed from drug choice, dose frequency, and/or treatment duration. To identify facility characteristics predictive of suboptimal UTI treatment, LTCFs with higher and lower rates of suboptimal treatment (≥median, < median) were compared using unconditional logistic regression models. Joinpoint regression models were used to quantify average percentage difference across facilities. Multilevel logistic regression models were used to quantify variation across facilities. The rate of potentially suboptimal antibiotic treatment varied from 1.7 to 34.2 per 10,000 bed-days across LTCFs. The average percentage difference in rates across facilities was 2.5% (95% confidence interval (CI): 2.4-2.7). The only facility characteristic predictive of suboptimal treatment was the incident rate of UTI per 10,000 bed-days (odds ratio: 4.9; 95% CI: 2.3-10.3). Multilevel models demonstrated that 94% of the variation between facilities was unexplained after controlling for resident and CLC characteristics. The median odds ratio for the full multilevel model was 1.37. Potentially suboptimal UTI treatment was variable across VA LTCFs. However, most of the variation across LTCFs was unexplained. Future research should continue to investigate factors that are driving suboptimal antibiotic treatment in LTCFs.
Sections du résumé
BACKGROUND
BACKGROUND
Suboptimal antibiotic treatment of urinary tract infection (UTI) is high in long-term care facilities (LTCFs) and likely varies between facilities. Large-scale evaluations have not been conducted.
AIM
OBJECTIVE
To identify facility-level predictors of potentially suboptimal treatment of UTI in Veterans Affairs (VA) LTCFs and to quantify variation across facilities.
METHODS
METHODS
This was a retrospective cohort study of 21,938 residents in 120 VA LTCFs (2013-2018) known as Community Living Centers (CLCs). Potentially suboptimal treatment was assessed from drug choice, dose frequency, and/or treatment duration. To identify facility characteristics predictive of suboptimal UTI treatment, LTCFs with higher and lower rates of suboptimal treatment (≥median, < median) were compared using unconditional logistic regression models. Joinpoint regression models were used to quantify average percentage difference across facilities. Multilevel logistic regression models were used to quantify variation across facilities.
FINDINGS
RESULTS
The rate of potentially suboptimal antibiotic treatment varied from 1.7 to 34.2 per 10,000 bed-days across LTCFs. The average percentage difference in rates across facilities was 2.5% (95% confidence interval (CI): 2.4-2.7). The only facility characteristic predictive of suboptimal treatment was the incident rate of UTI per 10,000 bed-days (odds ratio: 4.9; 95% CI: 2.3-10.3). Multilevel models demonstrated that 94% of the variation between facilities was unexplained after controlling for resident and CLC characteristics. The median odds ratio for the full multilevel model was 1.37.
CONCLUSION
CONCLUSIONS
Potentially suboptimal UTI treatment was variable across VA LTCFs. However, most of the variation across LTCFs was unexplained. Future research should continue to investigate factors that are driving suboptimal antibiotic treatment in LTCFs.
Identifiants
pubmed: 33549769
pii: S0195-6701(21)00037-2
doi: 10.1016/j.jhin.2021.01.019
pmc: PMC8045483
mid: NIHMS1675132
pii:
doi:
Substances chimiques
Anti-Infective Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
114-121Subventions
Organisme : HSRD VA
ID : I01 HX001894
Pays : United States
Organisme : HSRD VA
ID : IK2 HX002247
Pays : United States
Informations de copyright
Published by Elsevier Ltd.
Références
Ann Intern Med. 2015 Jul 21;163(2):73-80
pubmed: 26192562
Med J Aust. 2017 Jul 17;207(2):65-69
pubmed: 28701117
Clin Infect Dis. 2020 Aug 22;71(5):1168-1176
pubmed: 31673709
Pharmacoepidemiol Drug Saf. 2016 Jul;25(7):790-7
pubmed: 27174150
Am J Infect Control. 1999 Feb;27(1):10-9
pubmed: 9949373
Clin Infect Dis. 2011 Mar 1;52(5):e103-20
pubmed: 21292654
N Engl J Med. 2016 Jun 2;374(22):2192
pubmed: 27248641
J Antimicrob Chemother. 2011 Jul;66(7):1609-16
pubmed: 21596722
J Am Geriatr Soc. 2007 Aug;55(8):1231-5
pubmed: 17661962
J Am Geriatr Soc. 2005 Jul;53(7):1117-22
pubmed: 16108927
J Am Geriatr Soc. 2007 Aug;55(8):1236-42
pubmed: 17661963
JAMA Intern Med. 2015 Aug;175(8):1331-9
pubmed: 26121537
J Gen Intern Med. 2001 Jun;16(6):376-83
pubmed: 11422634
Clin Ther. 2005 Feb;27(2):258-62
pubmed: 15811491
Arch Intern Med. 2011 Mar 14;171(5):438-43
pubmed: 21403040
Am J Infect Control. 2020 Jan;48(1):13-18
pubmed: 31447117
Clin Infect Dis. 2019 May 2;68(10):1611-1615
pubmed: 31506700
Am J Infect Control. 2003 Feb;31(1):18-25
pubmed: 12548253
Stat Med. 2017 Sep 10;36(20):3257-3277
pubmed: 28543517
Dtsch Arztebl Int. 2010 May;107(21):361-7
pubmed: 20539810
J Am Coll Cardiol. 2015 Jan 20;65(2):111-21
pubmed: 25593051
Educ Psychol Meas. 2015 Dec;75(6):1063-1070
pubmed: 29795853
Clin Infect Dis. 2016 May 15;62(10):e51-77
pubmed: 27080992
Infect Control Hosp Epidemiol. 2019 Oct;40(10):1087-1093
pubmed: 31354115
Clin Infect Dis. 2020 Jun 26;:
pubmed: 32590839
J Am Med Dir Assoc. 2016 Feb;17(2):183.e1-16
pubmed: 26778488
J Am Geriatr Soc. 2008 Nov;56(11):2039-44
pubmed: 19016937
Clin Microbiol Infect. 2015 Jan;21(1):10-9
pubmed: 25636921
PLoS One. 2016 Nov 2;11(11):e0166012
pubmed: 27806107
J Am Geriatr Soc. 2013 Feb;61(2):289-90
pubmed: 23405923
Open Forum Infect Dis. 2019 Jan 18;6(2):ofz018
pubmed: 30815500
J Am Geriatr Soc. 2019 Feb;67(2):392-399
pubmed: 30517765
Infect Control Hosp Epidemiol. 2017 Aug;38(8):998-1001
pubmed: 28560933
BMC Infect Dis. 2013 Jun 27;13:290
pubmed: 23806017
Can J Infect Dis Med Microbiol. 2005 Nov;16(6):349-60
pubmed: 18159518
CMAJ. 2007 Oct 9;177(8):877-83
pubmed: 17923655
JAMA. 2003 Feb 12;289(6):719-25
pubmed: 12585950
Clin Infect Dis. 2020 Aug 22;71(5):1177-1178
pubmed: 31673710
Fed Regist. ;81(192):68688-872
pubmed: 27731960
Drugs Aging. 2015 Apr;32(4):295-303
pubmed: 25832969
J Am Med Dir Assoc. 2017 Nov 1;18(11):913-920
pubmed: 28935515