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The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection

Brown, Kevin Antoine; Daneman, Nick; Schwartz, Kevin L.; Langford, Bradley; McGeer, Allison; Quirk, Jacquelyn; Diong, Christina; Garber, Gary


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    "description": "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.   \n\nMethods 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 >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.   \n\nResults: 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\u20131.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28\u20131.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07\u20131.31).   \n\nConclusions Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection.", 
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    "title": "The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection", 
    "journal": {
      "title": "Clinical Infectious Diseases"
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    "publication_date": "2019-06-14", 
    "creators": [
      {
        "orcid": "0000-0002-1483-2188", 
        "name": "Brown, Kevin Antoine"
      }, 
      {
        "name": "Daneman, Nick"
      }, 
      {
        "name": "Schwartz, Kevin L."
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      {
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      {
        "name": "McGeer, Allison"
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      {
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      {
        "name": "Diong, Christina"
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