A randomized controlled trial in four European nations found that implementing a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for urinary tract infections (UTIs) in frail older adults, researchers reported today in The BMJ.
In the cluster randomized trial, healthcare providers at 38 clusters of one or more general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden were assigned to provide usual care or receive a multifaceted intervention consisting of a decision tool for appropriate antibiotic use for UTIs in frail older adults, supported by a toolbox with educational material. A participatory-action-research approach was used, with sessions for education, evaluation, and local tailoring of the intervention.
The primary outcome of the study, which included 1,041 frail adults aged 70 or older, was the number of antibiotic prescriptions for suspected UTIs per person per year. Data collection took place during a 5-month baseline period and a 7-month follow-up period.
Our multifaceted antibiotic stewardship intervention can be recommended for use in clinical practice to reduce antibiotic use for suspected urinary tract infections in frail older adults.
In the baseline period, the number of antibiotic prescriptions for suspected UTIs was 0.50 per person-year in the intervention group and 0.44 in the control group. During the follow-up period, that number fell to 0.27 per person-year in the intervention group and climbed to 0.58 in the control group. When adjusted for potential confounders, the patients in the intervention group had a 58% lower rate of receiving an antibiotic prescription for a suspected UTI compared with patients in the control group, with a rate ratio of 0.42 (95% confidence interval [CI], 0.26 to 0.68).
No differences between the intervention and control group were observed in the incidence of complications (less than 0.01 vs 0.05 per person-year), hospital referrals (less than 0.01 vs 0.05), admissions to hospital (0.01 vs 0.05), mortality within 21 days of suspected UTI (0 vs 0.01), and all-cause mortality (0.26 vs 0.26).
"Our multifaceted antibiotic stewardship intervention can be recommended for use in clinical practice to reduce antibiotic use for suspected urinary tract infections in frail older adults," the study authors concluded.