Urinary tract infections are the most common health-care associated infection in long-term care residents. However, it is important these infections are accurately diagnosed as there is also a high prevalence of asymptomatic bacteriuria in long-term care facilities.
Asymptomatic bacteriuria is a condition in which bacteria are present in the urine, but there are no clinical symptoms of an infection. Both the Infectious Diseases Society of America and Choosing Wisely Canada recommend against using antibiotics to treat asymptomatic bacteriuria. Despite these guidelines, nearly two-thirds of residents in long-term care facilities receive inappropriate antibiotic treatment for this condition.
Urinary tract infections are the most common health-care associated infection in long-term care residents. A recent research project in Regina
long-term care determined that more education for staff resulted in a significant decrease in the number of residents who receive inappropriate antibiotic treatment for this condition.
During the summer of 2017, the Regina Area Antimicrobial Stewardship Program conducted a research project to determine if more education for staff could have an effect on the rate of treatment of asymptomatic bacteriuria in a number of long-term care facilities in Regina. The study was led by U of S Pharmacy student, Christine Lee, who was funded as a summer research student by the Saskatchewan Health Authority research department. The study involved reviewing the medical charts of residents of seven long-term care facilities who had a positive urine culture and sensitivity test. The information gathered was used to assess both the appropriateness of the order for the urine culture and sensitivity test, as well as whether or not the resident had a urinary tract infection or asymptomatic bacteriuria, based on documented symptoms.
In order to promote changes in practice among long-term care facility clinical staff, an educational intervention was held at the midpoint of the study. Staff were invited to a 15-minute presentation which highlighted the evidence for asymptomatic bacteriuria treatment guidelines, the local data collected for each facility prior to the education session, and the diagnostic criteria for urinary tract infections.
At the study’s close, it was determined that there was a statistically significant decrease in the number of residents being treated with antibiotics for asymptomatic bacteriuria (from 90 per cent prior to the education session, to 63 per cent after). The study was published on December 1, 2018 and is available online
If you’d like more information or are interested in antimicrobial stewardship in your long-term care facility, please contact