Objectives
Our aim is to explore the challenges in the management of urinary tract infections (UTIs) in older adults and use these experiences in a tailored learning intervention in nursing homes to improve rational prescribing of antibiotics for UTIs in this population.
We also aim to evaluate the preventive effect of methenamine hippurate on recurrent UTIs in women ≥ 70 years in general practice. 
Outcomes
WP 1: Our results show that antibiotic prescribing decisions on UTIs in frail older adults are influenced by many factors and result from a complex process with patients, Informal Care Givers (ICGs), nursing staff and physicians. We present a model with an overview of the factors at play and can be used when designing future Antibiotic Stewardship Interventions (ASIs).
WP 2: Our results show that implementation of a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults in nursing homes. Participants in the intervention group had a lower rate of receiving an antibiotic prescription for a suspected urinary tract infection compared with participants in the usual care group, with a rate ratio of 0.42 (95%
confidence interval 0.26 to 0.68). No differences between intervention and control group were observed in the incidence of complications (<0.01 v 0.05 per person year), hospital referrals (<0.01 v 0.05), admissions to hospital (0.01 v 0.05), and mortality (0 v 0.01) within 21 days after suspected urinary tract infections, nor in all cause mortality (0.26 v 0.26).[SRHO1]
WP 3: Analysis of the data material is ongoing, results are expected in 2024.
Subprojects
- WP 1: Qualitative interview study on management of UTIs in nursing homes.
- WP 2: Multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for UTIs in nursing homes and home care organizations.
- WP 3: Triple-blind, randomised, placebo-controlled drug trial on the preventive effect of methenamine hipprate on recurrent UTIs in General Practice.
Background
UTIs are one of the most common reasons for prescribing antibiotics to older adults. UTIs represent a diagnostic challenge in this population as older patients are more vulnerable, and cognitive impairment makes history taking and clinical assessment difficult. At the same time, we know that as much as 50% of nursing home residents may have bacteria present in the urine at all times without having an infection requiring antibiotic treatment (asymptomatic bacteriuria). This can result in unnecessary antibiotic treatments, which in turn may cause adverse events for the patients and contribute to increased antimicrobial resistance (AMR).
Financing
- The Research Council of Norway via JPI-AMR (Joint Programming Initiative on Antimicrobial Resistance)
- NORM – Norwegian Surveillance System for Antimicrobial Drug Resistance
- Department of General Practice, Institute of Health and Society, University of Oslo
- Gidske and Peter Jacob Sørensens Reserach Trust.
- AMFF - The Norwegian Research Fund for General Practice
Cooperation
- University of Lodz
- Amsterdam UMC
- UMC Utrecht
- Sahlgrenska Academy, University of Gothenburg
- Region Västra Götaland
- Vestfold Hospital Trust
Project start and finish
2019-2024