Assessing antibiotic utilization of an antimicrobial stewardship program for urinary tract infections at a long-term acute care facility based on the revised McGeer Criteria

INTRODUCTION : The McGeer Criteria provides standardized guidance in long-term care facilities (LTCFs) for infection surveillance. Revisions were made in 2012, making the criteria specific for both residents with and without an indwelling catheter. An informal review showed frequent lack of supporting elements for testing or treatment of UTI’s at Gwinnett Extended Care Center (GECC)- Gwinnett Medical Center (GMC) LTCF.

RESEARCH QUESTION OR HYPOTHESIS: Examine antibiotic utilization of UTIs at GECC and assess the percentage of antibiotic initiation based on the revised McGeer Criteria.

STUDY DESIGN: A cross-sectional, retrospective chart review performed at an 89 bed LTCF.

METHODS: Patients were selected from the infection control practitioner’s (ICP) surveillance data. These were cases qualified or excluded by application of the 2012 revised McGeer Criteria. Residents with and without an indwelling catheter were included if they had at least one sign or symptom with a positive urine culture. Also included were residents with an indwelling catheter that meet previous criteria with no alternate diagnosis and an infectious presentation. Patient were excluded if there were being treated for other infectious disease. Outcomes were the number of patients receiving antibiotics for UTI, antibiotic administered and duration of treatment, interventions performed, and number of patients not meeting criteria for antibiotic as defined by the McGeer Criteria. RESULTS: About 75 patients were reviewed from the ICP surveillance data from March to November 2016 and two were excluded. About 93% of patients received at least one antibiotic. Various antibiotics were administered with most patients (n=23) receiving nitrofurantoin. Average treatment duration was 7.6 days. Approximately 21% of patients had an intervention performed. Over half of patients (n=42) did not meet criteria for antibiotics.

CONCLUSION: Less than half of the patients (n=31) had antibiotics initiated appropriately; therefore, utilizing the revised McGeer Criteria along with other stewardship efforts would improve appropriate use of antibiotics in LTCF patients.