A Multifaceted Antimicrobial Stewardship Program for the Treatment of Uncomplicated Cystitis in NHs

David A. Nace, MD, MPH1;Joseph T. Hanlon, PharmD, MS1,2;Christopher J. Crnich, MD, PhD3,4;et al

JAMA Intern Med.Published online May 11, 2020. doi:10.1001/jamainternmed.2020.1256

Question Can a multifaceted antimicrobial stewardship and quality improvement intervention reduce unnecessary treatment of unlikely cystitis (ie, nonspecific symptoms and positive culture results secondary to asymptomatic bacteriuria or a urine sample improperly collected for culture) among noncatheterized nursing home residents?

Findings This quality improvement study of 25 nursing homes, including 512 408 intervention facility resident-days and 443 912 control facility resident-days, found that the intervention was associated with a reduction in the incidence of antibiotic use for unlikely cystitis cases by 27% and a reduction in overall antibiotic use for any type of urinary tract infection by 17% compared with the control group. There were no significant differences in all-cause hospitalizations or mortality.

Meaning If implemented, these intervention tools may help nursing homes improve clinical care while meeting recently revised federal requirements for antimicrobial stewardship and quality improvement.