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- Title
Syndromic Antibiograms and Nursing Home Clinicians' Antibiotic Choices for Urinary Tract Infections.
- Authors
Taylor, Lindsay N.; Wilson, Brigid M.; Singh, Mriganka; Irvine, Jessica; Jolles, Sally A.; Kowal, Corinne; Bej, Taissa A.; Crnich, Christopher J.; Jump, Robin L. P.
- Abstract
This survey study evaluates whether providing nursing home clinicians with a urinary antibiogram improves empirical antibiotic treatment of urinary tract infections. Key Points: Question: Are urinary antibiograms associated with nursing home clinicians' empirical antibiotic choices for urinary tract infection? Findings: In this survey study of 317 nursing home clinicians simulating 4 clinical scenarios representing urinary tract infections in nursing home residents, clinicians provided antibiograms were more likely to choose both active and optimal empirical antibiotics. Meaning: These findings suggest that urinary antibiograms improve empirical antibiotic choice without increased use of overly broad initial therapy and that syndromic antibiograms should be further developed for use as an antibiotic stewardship tool in nursing homes. Importance: Empirical antibiotic prescribing in nursing homes (NHs) is often suboptimal. The potential for antibiograms to improve empirical antibiotic decision-making in NHs remains poorly understood. Objective: To determine whether providing NH clinicians with a urinary antibiogram improves empirical antibiotic treatment of urinary tract infections (UTIs). Design, Setting, and Participants: This was a survey study using clinical vignettes. Participants were recruited via convenience sampling of professional organization listservs of NH clinicians practicing in the US from December 2021 through April 2022. Data were analyzed from July 2022 to June 2023. Interventions: Respondents were randomized to complete vignettes using a traditional antibiogram (TA), a weighted-incidence syndromic combination antibiogram (WISCA), or no tool. Participants randomized to antibiogram groups were asked to use the antibiogram to empirically prescribe an antibiotic. Participants randomized to the no tool group functioned as controls. Main Outcomes and Measures: Empirical antibiotic selections were characterized as microbiologically (1) active and (2) optimal according to route of administration and spectrum of activity. Results: Of 317 responses, 298 (95%) were included in the analysis. Duplicate responses (15 participants), location outside the US (2 participants), and uninterpretable responses (2 participants) were excluded. Most respondents were physicians (217 respondents [73%]) and had over 10 years of NH practice experience (155 respondents [52%]). A mixed-effects logistic model found that use of the TA (odds ratio [OR], 1.41; 95% CI, 1.19-1.68; P <.001) and WISCA (OR, 1.54; 95% CI, 1.30-1.84; P <.001) were statistically superior to no tool when choosing an active empirical antibiotic. A similarly constructed model found that use of the TA (OR, 1.94; 95% CI, 1.42-2.66; P <.001) and WISCA (OR, 1.7; 95% CI, 1.24-2.33; P =.003) were statistically superior to no tool when selecting an optimal empirical antibiotic. Although there were differences between tools within specific vignettes, when compared across all vignettes, the TA and WISCA performed similarly for active (OR, 1.09; 95% CI, 0.92-1.30; P =.59) and optimal (OR, 0.87; 95% CI, 0.64-1.20; P =.69) antibiotics. Conclusions and Relevance: Providing NH clinicians with a urinary antibiogram was associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions. Although the antibiogram format was not associated with decision-making in aggregate, context-specific effects may have been present, supporting further study of syndromic antibiograms in clinical practice.
- Subjects
UNITED States; ANTIBIOTICS; ANTIMICROBIAL stewardship; CONFIDENCE intervals; URINARY tract infections; CROSS-sectional method; PHYSICIANS' attitudes; DESCRIPTIVE statistics; RESEARCH funding; DRUG resistance in microorganisms; DECISION making in clinical medicine; STATISTICAL sampling; LOGISTIC regression analysis; ODDS ratio; MICROBIAL sensitivity tests
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2349544
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.49544