Multifaceted stewardship intervention safely reduces antibiotic prescribing for suspected urinary tract infection among frail older adults.
Esther A.R. Hartman, from the Vrije University of Amsterdam in the Netherlands, and colleagues conducted a cluster randomized controlled trial to examine whether antibiotic prescribing for suspected urinary tract infections in frail older adults can be reduced with a multifaceted antibiotic stewardship intervention for health care professionals, which included a decision tool for appropriate antibiotic use, supported by a toolbox containing educational material. A total of 1,041 frail older adults aged 70 years and older from 38 clusters of one or more general practices and older adult care organizations were included, contributing 411 person-years to the follow-up period. Care as usual was provided by the control group.
The researchers found that the numbers of antibiotic prescriptions for suspected urinary tract infections were 54 prescriptions in 202 person-years in the intervention group and 121 prescriptions in 209 person-years in the usual care group in the follow-up period (0.27 versus 0.58 per person-year). Compared with participants in the usual care group, those in the intervention group had a lower rate of receiving an antibiotic prescription, with a rate ratio of 0.42. Secondary outcomes were similar between the intervention and control groups, including complications (<0.01 versus0.05 per person-year), hospital referrals (<0.01 versus0.05), admissions to hospital (0.01 versus 0.05), mortality (0 versus 0.01) within 21 days after suspected urinary tract infections, and all-cause mortality (0.26 versus 0.26).
“A multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in older adults,” the authors write. “Implementation across diverse older adult care settings requires the active participation of all healthcare professionals, as well as tailoring to the local situation.”