OBJECTIVES Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. DESIGN Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. SETTING AND PARTICIPANTS Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). METHODS EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. RESULTS Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. CONCLUSIONS AND IMPLICATIONS One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship.

中文翻译：

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疗养院居民使用抗生素治疗尿路感染的流行病学

目标 描述大量美国疗养院居民使用抗生素治疗尿路感染 (UTI)。设计 对 2017 年 4 月至 10 月期间进行的一项多州、为期 1 天的抗菌药物使用流行率调查的数据进行分析。 地点和参与者 美国新发感染计划 (EIP) 的 10 个州的 161 家疗养院的居民。方法 EIP 工作人员审查了疗养院的医疗记录，以收集居民接受的全身性抗菌药物的数据，包括治疗地点、使用理由和计划持续时间。对于治疗部位记录为泌尿道的药物，计算每 100 名疗养院居民的汇总平均和疗养院特定流行率，并报告按选定特征划分的药物比例。数据在 SAS 9.4 版中进行分析。结果 在 15 个中，276 名居民中，407 人接受了 424 种抗生素治疗尿路感染。UTI 使用抗生素的汇总平均流行率为每 100 名居民 2.66 人；疗养院特定比率范围从 0 到 13.6。四分之一的抗生素用于 UTI 预防，中位计划持续时间为 111 天，而 UTI 治疗则为 7 天（P < .001）。氟喹诺酮类药物是最常用的（18%）药物类别。结论和意义 38 名居民中就有 1 人在某一天因 UTI 接受抗生素治疗，疗养院特定的患病率相差 10 倍以上。尽管在疗养院的老年人中支持这种做法的证据有限，但 UTI 预防很常见，而且计划持续时间很长。一半用于治疗 UTI 的抗生素的计划持续时间≥7 天。氟喹诺酮类是最常用的抗生素，尽管它们与严重的不良事件有关，尤其是在体弱和老年人群中。这些发现有助于确定疗养院抗生素管理的优先实践。