Antibiotic stewardship in lower urinary tract infections among the elderly at a district general hospital

Abstract

Objectives: We 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 the East Midlands of the United Kingdom. Participants: A total of 77 patients aged 65 years and older who underwent urine culture for suspected lower urinary tract infection were included in the study. Design: This was a prospective case series of emergency hospital admissions collected over eight months in acute elderly medicine wards, with two educational interventions implemented during the second and third months 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 after the poster intervention, and 17 patients were involved following the teaching intervention. Several months following the intervention, nine 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: 1.08-12.03, Ꭓ2=4.56, p=0.033). Compared to the pre-intervention period, antibiotic prescribing was found to be five times more appropriate (OR=5.05, 95% CI: 0.96-26.66, Ꭓ2=3.91, p=0.048) after all educational interventions were implemented. Catheter-associated infections also showed a significant reduction, albeit with poor statistical correlation. Conclusion: Targeted educational interventions, including informational posters and teaching sessions, improved appropriate diagnosis and antibiotic prescribing for LUTIs and ASB in elderly hospitalized patients within the scope of this study.