Prospective evaluation of the management of urinary tract infections in 134 French nursing homes.
Med Mal Infect
; 48(5): 359-364, 2018 Aug.
Article
em En
| MEDLINE
| ID: mdl-29747905
ABSTRACT
OBJECTIVE:
Prospective assessment of the management of urinary tract infections (UTI) in the nursing homes of the Hauts-de-France region. PATIENTS ANDMETHODS:
A 50-question form had to be filled in for up to five consecutive residents treated for UTI in each nursing home. If necessary, diagnoses were reclassified according to the 2014 French Infectious Diseases Society guidelines. Analyses were presented per supposed (reported) and reclassified diagnoses.RESULTS:
Of 397 contacted facilities, 134 participated and informed 444 UTI episodes. Reported diagnostic criteria were burning urination (32%), malodorous urine (29%), confusion (28%), and turbid urine (19%). Twenty-one percent of diagnoses were based on erroneous criteria. Less than 50% of residents had a urine dipstick test performed and 94% a urine culture. The main pathogen was Escherichia coli. Reported indications were uncomplicated cystitis (32%), unspecified UTI (26%), complicated cystitis (9%), while no reason was given in 25% of cases. Only 10% of diagnoses were consistent with the guidelines complicated cystitis (49%), asymptomatic bacteriuria (21%), acute pyelonephritis (21%), male UTI (9%). Almost 85% of prescriptions were active on the isolated bacteria. The empirical antibiotic therapy was consistent with the diagnosis in 16% of cases (30% for reclassified diagnoses). The two most prescribed antibiotic classes were fluoroquinolones (22.1%) and oral third-generation cephalosporins (19.1%). Only two of 157 possible de-escalations were performed. Duration of treatment was adequate for 19% of UTIs (9.6% of reclassified cases).CONCLUSION:
Our study revealed multiple deficiencies in diagnosis, antibiotic choice, treatment duration, and reevaluation.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções Urinárias
/
Casas de Saúde
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Observational_studies
/
Qualitative_research
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Humans
/
Male
País/Região como assunto:
Europa
Idioma:
En
Revista:
Med Mal Infect
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
França