Antimicrobial Stewardship in UTIs in Nursing Homes
Antimicrobial Stewardship in UTIs in Nursing Homes
Background: The widespread inappropriate use of antimicrobial substances drives resistance
 development at the individual and population level all over the world. In long-term care
 facilities (LTCF), antibiotics are among the most frequently prescribed medications. More
 than one third of antibiotics prescribed in LTCFs are for urinary tract infections (UTI).
 Studies have shown that 30 - 40% of antibiotic courses prescribed in LTCFs were unnecessary
 and that more than two-thirds were inappropriate based on society guidelines.

 Preliminary data: A surveillance study on healthcare-associated UTIs at LTCFs of the
 Geriatric Health Centers Graz revealed that guideline recommendations on antimicrobial choice
 were met in only 50% of patients. The most frequently used antimicrobial substances for UTI
 were quinolones.

 Aims: Using a multifaceted bundle of antimicrobial stewardship interventions consisting of
 clinical practice guidelines, care pathways and local as well as web-based education and
 training targeting nursing staff as well as physicians we aim to improve the quality of
 antimicrobial prescriptions for UTIs in four LTCFs in Graz, Austria.

 Design: Non-randomized cluster controlled intervention study. Setting: The Geriatric Health
 Centers Graz are a local institution comprising among others 4 LTCFs (total of 400 beds).
 These will serve as intervention group. Four LTCFs located in the surroundings of Graz will
 serve as control group.

 Intervention: The main components of the intervention are 1) two sessions of voluntary
 continuing medical education on the urinary tract infection program in each LTCF for
 physicians and nursing staff, 2) distribution of educations materials such as written
 guidelines on antibiotic prescribing including a smart phone friendly version, 3)
 implementation of the project homepage as a platform to distribute guidelines and educational
 videos and to enable physicians to ask questions which will be answered by an infectious
 disease physician.

 Outcomes: The primary outcome will be the proportion of adequate prescriptions (adequate in
 terms of antimicrobial choice). Secondary outcomes include proportion of adequate
 prescriptions (adequate in terms of decision to treat), number of cases with clinical
 failure, number of admissions to hospital due to UTI, number of adverse events attributed to
 antimicrobial treatment for UTI, percentage of extended spectrum betalactamase (ESBL)
 producing enterobacteria isolated from urinary cultures
Inclusion Criteria:

 -  residents living in the participating long term care facilities who experience urinary
 tract infections (UTI)

 Exclusion Criteria:

 -  residents without UTI