Antibiotic Stewardship in Lower Urinary Tract Infections among the Elderly at a District General Hospital
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Abstract
Objectives This study aimed to evaluate the management of lower urinary tract infections (LUTIs) in elderly inpatients, to determine the prevalence of inappropriate treatment of asymptomatic bacteriuria (ASB), and to assess the impact of targeted educational interventions on antibiotic prescribing accuracy. Settings An acute general hospital in East Midlands of the United Kingdom. Participants Seventy-seven patients aged 65 and older who have had a urine culture due to suspected diagnosis of lower urinary tract infection. Design Prospective case series of emergency hospital admissions collected over an 8-month period to acute elderly medicine wards. Implementation of two educational interventions at the second and third month of the study period. Methods Data relating to demographics, catheterization status, presenting symptoms, urine dipstick usage, culture collection methods, and antibiotic prescription patterns were obtained from electronic and paper records as part of audit number 1688 registered at the hospital trust. Interventions included the display of an informational poster based on NICE guidelines and a dedicated educational teaching session for clinicians. In total, 19 patients were involved pre-intervention. A total of 58 patients were involved post-intervention. Among the post intervention cohort, 32 patients were involved post-poster intervention, and 17 patients were involved post-teaching intervention. Several months following intervention, 9 patients were involved in the study. Results Initial findings revealed suboptimal adherence to national guidelines, with 50% (n=5) of asymptomatic patients with negative cultures inappropriately prescribed antibiotics. Following the poster intervention, prescribing was found to be three and a half times more appropriate for LUTIs than the pre-intervention period (OR=3.61, 95%CI 1.08 to 12.03, (⍰ 2 =4.56, p=0.033). Compared to the pre-intervention period antibiotic prescribing was found to be five times (OR=5.05, 95%CI 0.96 to 26.66, ⍰ 2 =3.91, p=0.048) more appropriate after all educational interventions implemented. Catheter-associated infections also showed a significant reduction, albeit with poor statistical correlation. Conclusion Targeted educational interventions, including informational posters and teaching sessions, were observed to improve appropriate diagnosis and antibiotic prescribing for LUTIs and ASB in elderly hospitalized patients within the scope of this study.
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Abstract
Objectives This study aimed to evaluate the management of lower urinary tract infections (LUTIs) in elderly inpatients, to determine the prevalence of inappropriate treatment of asymptomatic bacteriuria (ASB), and to assess the impact of targeted educational interventions on antibiotic prescribing accuracy.
Settings An acute general hospital in East Midlands of the United Kingdom.
Participants Seventy-seven patients aged 65 and older who have had a urine culture due to suspected diagnosis of lower urinary tract infection.
Design Prospective case series of emergency hospital admissions collected over an 8-month period to acute elderly medicine wards. Implementation of two educational interventions at the second and third month of the study period.
Methods
Data relating to demographics, catheterization status, presenting symptoms, urine dipstick usage, culture collection methods, and antibiotic prescription patterns were obtained from electronic and paper records as part of audit number 1688 registered at the hospital trust. Interventions included the display of an informational poster based on NICE guidelines and a dedicated educational teaching session for clinicians. In total, 19 patients were involved pre-intervention. A total of 58 patients were involved post-intervention. Among the post intervention cohort, 32 patients were involved post-poster intervention, and 17 patients were involved post-teaching intervention. Several months following intervention, 9 patients were involved in the study.
Results
Initial findings revealed suboptimal adherence to national guidelines, with 50% (n=5) of asymptomatic patients with negative cultures inappropriately prescribed antibiotics. Following the poster intervention, prescribing was found to be three and a half times more appropriate for LUTIs than the pre-intervention period (OR=3.61, 95%CI 1.08 to 12.03, (⍰2 =4.56, p=0.033). Compared to the pre-intervention period antibiotic prescribing was found to be five times (OR=5.05, 95%CI 0.96 to 26.66, ⍰2=3.91, p=0.048) more appropriate after all educational interventions implemented. Catheter-associated infections also showed a significant reduction, albeit with poor statistical correlation.
Conclusion
Targeted educational interventions, including informational posters and teaching sessions, were observed to improve appropriate diagnosis and antibiotic prescribing for LUTIs and ASB in elderly hospitalized patients within the scope of this study.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
This study did not receive any funding
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
This project was conducted as a clinical audit aimed at evaluating and improving the quality of antibiotic prescribing practices for urinary tract infections within the elderly medicine ward at the Northampton General Hospital. As a quality improvement initiative, this audit was registered with the hospital's governance framework and was deemed to fall under standard clinical practice evaluation, thereby not requiring formal review by an Institutional Review Board or Research Ethics Committee, in line with national guidelines for audit activities.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Footnotes
Amendments made to the appendix
Data Availability
All data produced in the present study are available upon reasonable request to the authors
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