Journal article Open Access
Brown, Kevin Antoine;
Daneman, Nick;
Schwartz, Kevin L.;
Langford, Bradley;
McGeer, Allison;
Quirk, Jacquelyn;
Diong, Christina;
Garber, Gary
<?xml version='1.0' encoding='utf-8'?> <resource xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://datacite.org/schema/kernel-4" xsi:schemaLocation="http://datacite.org/schema/kernel-4 http://schema.datacite.org/meta/kernel-4.1/metadata.xsd"> <identifier identifierType="URL">https://zenodo.org/record/3666982</identifier> <creators> <creator> <creatorName>Brown, Kevin Antoine</creatorName> <givenName>Kevin Antoine</givenName> <familyName>Brown</familyName> <nameIdentifier nameIdentifierScheme="ORCID" schemeURI="http://orcid.org/">0000-0002-1483-2188</nameIdentifier> </creator> <creator> <creatorName>Daneman, Nick</creatorName> <givenName>Nick</givenName> <familyName>Daneman</familyName> </creator> <creator> <creatorName>Schwartz, Kevin L.</creatorName> <givenName>Kevin L.</givenName> <familyName>Schwartz</familyName> </creator> <creator> <creatorName>Langford, Bradley</creatorName> <givenName>Bradley</givenName> <familyName>Langford</familyName> </creator> <creator> <creatorName>McGeer, Allison</creatorName> <givenName>Allison</givenName> <familyName>McGeer</familyName> </creator> <creator> <creatorName>Quirk, Jacquelyn</creatorName> <givenName>Jacquelyn</givenName> <familyName>Quirk</familyName> </creator> <creator> <creatorName>Diong, Christina</creatorName> <givenName>Christina</givenName> <familyName>Diong</familyName> </creator> <creator> <creatorName>Garber, Gary</creatorName> <givenName>Gary</givenName> <familyName>Garber</familyName> </creator> </creators> <titles> <title>The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection</title> </titles> <publisher>Zenodo</publisher> <publicationYear>2019</publicationYear> <dates> <date dateType="Issued">2019-06-14</date> </dates> <resourceType resourceTypeGeneral="Text">Journal article</resourceType> <alternateIdentifiers> <alternateIdentifier alternateIdentifierType="url">https://zenodo.org/record/3666982</alternateIdentifier> </alternateIdentifiers> <relatedIdentifiers> <relatedIdentifier relatedIdentifierType="DOI" relationType="IsIdenticalTo">10.1093/cid/ciz482</relatedIdentifier> </relatedIdentifiers> <rightsList> <rights rightsURI="info:eu-repo/semantics/openAccess">Open Access</rights> </rightsList> <descriptions> <description descriptionType="Abstract">Background: Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. Methods We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering &gt;90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. Results: A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18–1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28–1.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07–1.31). Conclusions Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection.</description> </descriptions> </resource>
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