Young healthcare worker speaking with elderly person in wheelchair

A multifactorial training program for health professionals is capable of halving the use of antibiotics against urinary tract infections (UTIs) while maintaining patient safety, according to a study published in the British Medical Journal.

The study of 1,041 frail older people at 38 senior care homes in the Netherlands, Norway, Poland and Sweden took place between September 2019 to June 2021. It was designed to examine the overprescription of antibiotics for older people with suspected UTIs and the effects of a “multifaceted antibiotic stewardship intervention” intended to reduce the unnecessary prescriptions.

The antibiotic stewardship intervention training program consisted of theory instruction followed by discussion in small groups about optimal care for older adults with suspected UTIs. It included a decision tool for appropriate antibiotic use supported by a toolbox with educational material. Doctors, nurses and nurse assistants taking part devised action plans adapted for their own respective workplaces. A participatory-action-research approach was used for implementation, with sessions for education, evaluation and local tailoring of the intervention.

The results show that the intervention was effective: The outcome was a halving of the number of UTI antibiotic courses of treatment compared with a control group that received care as usual. Importantly, the study also showed that patient safety was unaffected. There were no intergroup differences in terms of complications, hospitalizations or deaths ensuing from UTIs.

The researchers also performed subgroup analyses to assess the outcomes in groups in each country, male or female, age younger or older than 80 years, and the presence of dementia, urinary incontinence and an indwelling catheter.

“From our subgroup analyses, the antibiotic stewardship intervention appears to be effective across most subgroups, indicating wide applicability for implementation,” the researchers wrote. “The effectivity across diverse settings in our study makes it plausible that tailored implementation in other countries would be effective as well. Moreover, we find it promising that the intervention effect appeared to be much stronger in patients with dementia, because antibiotic stewardship usually is difficult in this population.”

They added that parallel work is needed to improve prevention of urinary tract infections, optimize choice and duration of antibiotic treatment, and reduce unnecessary prophylactic antibiotic use.