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

Published online by Cambridge University Press:  29 July 2019

Haley J. Appaneal ,
Aisling R. Caffrey ,
Vrishali V. Lopes ,
Christopher J. Crnich ,
David M. Dosa  and
Kerry L. LaPlante
Haley J. Appaneal*
Affiliation:
Infectious Diseases Research Program, Providence Veterans’ Affairs Medical Center, Providence, Rhode Island Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island College of Pharmacy, University of Rhode Island, Kingston, Rhode Island Brown University School of Public Health, Providence, Rhode Island
Aisling R. Caffrey
Affiliation:
Infectious Diseases Research Program, Providence Veterans’ Affairs Medical Center, Providence, Rhode Island Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island College of Pharmacy, University of Rhode Island, Kingston, Rhode Island Brown University School of Public Health, Providence, Rhode Island
Vrishali V. Lopes
Affiliation:
Infectious Diseases Research Program, Providence Veterans’ Affairs Medical Center, Providence, Rhode Island
Christopher J. Crnich
Affiliation:
William S. Middleton VA Hospital, Madison, Wisconsin University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
David M. Dosa
Affiliation:
Infectious Diseases Research Program, Providence Veterans’ Affairs Medical Center, Providence, Rhode Island Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island Brown University School of Public Health, Providence, Rhode Island
Kerry L. LaPlante
Affiliation:
Infectious Diseases Research Program, Providence Veterans’ Affairs Medical Center, Providence, Rhode Island Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, Rhode Island College of Pharmacy, University of Rhode Island, Kingston, Rhode Island Brown University School of Public Health, Providence, Rhode Island Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island
*
Author for correspondence: Haley J. Appaneal, Email: haley.appaneal@va.gov
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1087 - 1093
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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