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Editorial| Volume 19, ISSUE 9, P733-735, September 2018

Uncomplicated Cystitis in Nursing Home Residents: A Practical Guide to Diagnosis and Management

DOI:https://doi.org/10.1016/j.jamda.2018.07.015
Uncomplicated Cystitis in Nursing Home Residents: A Practical Guide to Diagnosis and Management
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      Suspected urinary tract infections (UTIs) are the most commonly encountered and treated infections in nursing homes.
      • Zimmerman S.
      • Sloane P.D.
      • Bertrand R.
      • et al.
      Successfully reducing antibiotic prescribing in nursing homes.
      J Am Geriatr Soc. 2014; 62: 907-912
      , 
      • Dwyer L.L.
      • Harris-Kojetin L.D.
      • Valverde R.H.
      • et al.
      Infections in long-term care populations in the United States.
      J Am Geriatr Soc. 2013; 61: 342-349
      The incidence of symptomatic UTI approaches 2.5 cases per 1000 resident-days,
      • Nicolle L.E.
      Urinary tract infection in long-term care facilities.
      Healthcare Infect. 2014; 19: 4-12
      and approximately one-third of antibiotics administered in nursing homes are attributable to UTI.
      • Thompson N.D.
      • LaPlace L.
      • Epstein L.
      • et al.
      Prevalence of antimicrobial use and opportunities to improve prescribing practices in U.S. nursing homes.
      J Am Med Dir Assoc. 2016; 17: 1151-1153
      Nevertheless, most antibiotic prescriptions for suspected UTI in nursing homes are inappropriate,
      • Eure T.
      • LaPlace L.L.
      • Melchreit R.
      • et al.
      Measuring antibiotic appropriateness for urinary tract infections in nursing home residents.
      Infect Control Hosp Epidemiol. 2017; 38: 998-1001
      resulting in high risks of antibiotic-associated harms, including an 8-fold greater odds of Clostridium difficile infection when compared to unexposed residents.
      • Rotjanapan P.
      • Dosa D.
      • Thomas K.S.
      Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes.
      Arch Intern Med. 2011; 171: 438-443
      Consequently, antibiotic stewardship programs are now mandated by the Centers for Medicare and Medicaid Services.
      • CMS
      Reform of requirements for long-term care facilities.
      https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities
      Date: 2017
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      References

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        • Sloane P.D.
        • Bertrand R.
        • et al.
        Successfully reducing antibiotic prescribing in nursing homes.
        J Am Geriatr Soc. 2014; 62: 907-912
        View in Article
        • Dwyer L.L.
        • Harris-Kojetin L.D.
        • Valverde R.H.
        • et al.
        Infections in long-term care populations in the United States.
        J Am Geriatr Soc. 2013; 61: 342-349
        View in Article
        • Nicolle L.E.
        Urinary tract infection in long-term care facilities.
        Healthcare Infect. 2014; 19: 4-12
        View in Article
        • Thompson N.D.
        • LaPlace L.
        • Epstein L.
        • et al.
        Prevalence of antimicrobial use and opportunities to improve prescribing practices in U.S. nursing homes.
        J Am Med Dir Assoc. 2016; 17: 1151-1153
        View in Article
        • Eure T.
        • LaPlace L.L.
        • Melchreit R.
        • et al.
        Measuring antibiotic appropriateness for urinary tract infections in nursing home residents.
        Infect Control Hosp Epidemiol. 2017; 38: 998-1001
        View in Article
        • Rotjanapan P.
        • Dosa D.
        • Thomas K.S.
        Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes.
        Arch Intern Med. 2011; 171: 438-443
        View in Article
        • CMS
        Reform of requirements for long-term care facilities.
        (Available at:)
        https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities
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      Article info

      Footnotes

      This work was supported by 2T32AI007517-16 at the Yale School of Medicine, Section of Infectious Diseases.

      The authors declare no conflicts of interest.

      Identification

      DOI: https://doi.org/10.1016/j.jamda.2018.07.015

      Copyright

      © 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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