目的:调查体弱老年人尿路感染(UTI)国家指南出台3年后的指南依从性。适当使用尿液试纸,治疗决定,和抗生素药物的选择与(疑似)尿路感染没有导管的居民进行了检查。
方法:观察性前瞻性研究。
方法:参加荷兰哨兵护理家庭监测网络的19个护理家庭。
方法:截至2021年9月,为期3个月,医生在电子健康记录中记录了额外的临床信息,以防发生(疑似)UTI。根据这些信息,对指南建议的依从性进行了评估.不依从分为2类:(1)从业者报告的“故意不依从”和(2)“否则不依从”适用于记录的信息与指南建议不一致的所有其他病例。
结果:共分析了469名居民的532例(疑似)UTI。在455例(86%)中,使用试纸。对于231例临床体征和症状已经表明未根据指南进行UTI治疗的病例,196例(85%)仍不恰当地订购试纸。在69%的病例中决定开或扣留抗生素,6%的人故意不遵守,另有25%的人不遵守。处方抗生素的类型与推荐的膀胱炎抗生素的依附性为88%,UTI的依附性为48%。总的来说,对于40%的可疑尿路感染,可以建立对所有相关建议的遵守,9%的从业者报告有意不遵守指南.
结论:在荷兰疗养院管理可疑UTI的所有临床阶段都有相当大的改进空间,特别是关于患者的临床体征和症状对适当使用试纸和抗生素UTI治疗的重要性。
OBJECTIVE: To investigate
guideline adherence 3 years after the introduction of a national
guideline on urinary tract infections (UTIs) in frail older adults. Appropriate use of urine dipstick tests, treatment decisions, and antibiotic drug choices in residents with (suspected) UTIs without a catheter were examined.
METHODS: Observational prospective study.
METHODS: Nineteen nursing homes participating in a Dutch Sentinel Nursing Home Surveillance Network.
METHODS: As of September 2021, for a 3-month period, medical practitioners recorded additional clinical information in the electronic health record in case of a (suspected) UTI. Based on this information, adherence to
guideline recommendations was assessed. Nonadherence was classified into 2 categories: (1) \"intentional nonadherence\" as reported by practitioners and (2) \"nonadherence otherwise\" applied to all other cases where the recorded information was discordant with the
guideline recommendations.
RESULTS: A total of 532 cases of (suspected) UTIs from 469 residents were analyzed. In 455 cases (86%), dipsticks were used. For the 231 cases where clinical signs and symptoms already indicated no UTI treatment according to the
guideline, a dipstick was still inappropriately ordered in 196 cases (85%). The decision to prescribe or withhold antibiotics was in 69% of the cases adherent, in 6% intentionally nonadherent, and in 25% nonadherent otherwise. The type of prescribed antibiotic was adherent to the recommended antibiotics for cystitis in 88% and for UTIs with signs of tissue invasion in 48%. Overall, for 40% of suspected UTIs, adherence to all relevant recommendations could be established, and in 9% practitioners reported intentional nonadherence to the
guideline.
CONCLUSIONS: There is considerable room for improvement in all clinical stages of managing a suspected UTI in Dutch nursing homes, particularly with regard to the importance of patient\'s clinical signs and symptoms for appropriate dipstick use and antibiotic UTI treatments.