National trends in the treatment of urinary tract infections among Veterans' Affairs Community Living Center residents.

Appaneal HJ, Caffrey AR, Lopes VV, Crnich CJ, Dosa DM, LaPlante KL. National trends in the treatment of urinary tract infections among Veterans' Affairs Community Living Center residents. Infection control and hospital epidemiology. 2019 Oct 1; 40(10):1087-1093.

Related HSR&D Project(s)

• IIR 15-120 – Improving Antimicrobial Stewardship in Veterans Affairs (VA) Community Living Centers
• CDA 15-260 – Development of a Stewardship Intervention for CLC Pharmacists to Improve UTI Treatments

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Abstract:

OBJECTIVE: To describe urinary tract infection (UTI) treatment among Veterans'' Affairs (VA) Community Living Centers (CLCs) nationally and to assess related trends in antibiotic use. DESIGN: Descriptive study. SETTING AND PARTICIPANTS: All UTI episodes treated from 2013 through 2017 among residents in 110 VA CLCs. UTI episodes required collection of a urine culture, antibiotic treatment, and a UTI diagnosis code. UTI episodes were stratified into culture-positive and culture-negative episodes. METHODS: Frequency and rate of antibiotic use were assessed for all UTI episodes overall and were stratified by culture-positive and culture-negative episodes. Joinpoint software was used for regression analyses of trends over time. RESULTS: We identified 28,247 UTI episodes in 14,983 Veterans. The average age of Veterans was 75.7 years, and 95.9% were male. Approximately half of UTI episodes (45.7%) were culture positive and 25.7% were culture negative. Escherichia coli was recovered in 34.1% of culture-positive UTI episodes, followed by Proteus mirabilis and Klebsiella spp, which were recovered in 24.5% and 17.4% of culture-positive UTI episodes, respectively. The rate of total antibiotic use in days of therapy (DOT) per 1,000 bed days decreased by 10.1% per year (95% CI, -13.6% to -6.5%) and fluoroquinolone use (ciprofloxacin or levofloxacin) decreased by 14.5% per year (95% CI, -20.6% to -7.8%) among UTI episodes overall. Similar reductions in rates of total antibiotic use and fluoroquinolone use were observed among culture-positive UTI episodes and among culture-negative UTI episodes. CONCLUSION: Over a 5-year period, antibiotic use for UTIs significantly decreased among VA CLCs, as did use of fluoroquinolones. Antibiotic stewardship efforts across VA CLCs should be applauded, and these efforts should continue.