Journal article Open Access
Brown, Kevin Antoine;
Daneman, Nick;
Schwartz, Kevin L.;
Langford, Bradley;
McGeer, Allison;
Quirk, Jacquelyn;
Diong, Christina;
Garber, Gary
{ "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.", "license": "", "creator": [ { "@id": "https://orcid.org/0000-0002-1483-2188", "@type": "Person", "name": "Brown, Kevin Antoine" }, { "@type": "Person", "name": "Daneman, Nick" }, { "@type": "Person", "name": "Schwartz, Kevin L." }, { "@type": "Person", "name": "Langford, Bradley" }, { "@type": "Person", "name": "McGeer, Allison" }, { "@type": "Person", "name": "Quirk, Jacquelyn" }, { "@type": "Person", "name": "Diong, Christina" }, { "@type": "Person", "name": "Garber, Gary" } ], "headline": "The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection", "image": "https://zenodo.org/static/img/logos/zenodo-gradient-round.svg", "datePublished": "2019-06-14", "url": "https://zenodo.org/record/3666982", "@context": "https://schema.org/", "identifier": "https://doi.org/10.1093/cid/ciz482", "@id": "https://doi.org/10.1093/cid/ciz482", "@type": "ScholarlyArticle", "name": "The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection" }
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