Antibiotics are one of the most commonly prescribed medications in long-term care facilities (LTCFs), but up to 75% are incorrectly prescribed. The intensity of antibiotic use to treat urinary tract infections (UTIs) in LTCFs increases the risk for life-threatening adverse effects. Overuse and misuse of these lifesaving medications has contributed to the rapid emergence of antibiotic-resistant bacteria and Clostridium difficile infection. The Pennsylvania Patient Safety Authority analyzed UTI events reported from Pennsylvania LTCFs during the 30-month period from April 1, 2014, through September 30, 2016, to study (1) triggers for prescribing antibiotics for UTIs, and (2) the frequency of prescriptions for broad-spectrum antibiotics specifically associated with antibiotic-resistant bacteria and C. difficile. The analysis reveals deviance from national practice guidelines for treating UTIs and the suboptimal use of antibiotics for mixed growth and contaminated specimens. This crisis of incorrect antibiotic use and the downstream effects of antibiotic-resistant bacteria and C. difficile demonstrate an urgent need for immediate adoption of best practices for accurate identification and optimal treatment of UTIs in the elderly including: (1) integrating strategies to overcome barriers to antibiotic stewardship, and (2) improving communication between nursing, prescribing staff, and healthcare facilities in the continuum of care. A Pennsylvania LTCF shares its success story demonstrating the effectiveness of these strategies in reducing suboptimal antibiotic use.
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