Influence of inadequate antimicrobial therapy on prognosis in elderly patients

Working or Permalink Article Access Link

A. Esparcia, A. Artero, J. M. Eiros, M. Balaguer, M. Madrazo, J. Alberola, and J. M. Nogueira.

doi: 10.1016/j.ejim.2014.04.009.

A. L. Flores-Mireles, J. N. Walker, M. Caparon, and Hultgren

Nature Reviews, 10.1038/nrmicro3432.

V.H. Lim, T. Whitehurst, E. Usoro, et al.

The BMJ journal can be found at http://bmjopenquality.bmj.com/content/3/1/u203314.w1503

L. Mody and Juthani-Mehta Jamaa

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194886/

Impact of inadequate antibiotic therapy on prognosis in elderly patients with severe urinary tract infections (Article Title and Year Published).

2014

Urinary tract infections: epidemiology, mechanisms of infection and treatment options

2015

Management of urinary tract infections in elderly patients: Strategies for improvement

2014

Urinary tract infections in older women: a clinical review.

2014

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

Hypothesis: Inadequate empirical antimicrobial therapy (IEAT) in the ICU is associated with adverse outcomes.

Aim: To assess the impacts of IEAT in ICU.

Research Question: How do science studies address the host-pathogen interface of UTI?

Purpose: to assess the host-pathogen interface of UTI cases including the pathophysiology and clinical treatment

Research question: What are the effective measures needed to increase efficiency of UTI control and treatment?

Aim: to consider the strategies for improving UTI management among the elderly

Purpose: To review the management of asymptomatic bacteriuria and symptomatic UTI and review UTI prevention among elderly women.

Design (Type of Quantitative, or Type of Qualitative)

Design: Cross-sectional design to analyze the prevalence of IEAT

Systematic review of literature on UTI physiology and treatment

Review assessment of the UTI management in a district hospital setting (Qualitative study)

Qualitative study: reviewing literature of UTI management among elderly women.

Setting/Sample

270 patients with mean age of 83.7 years

The article reviewed around 10 articles on the subject

Involved 160 patients aged between 65 and 95 years. The district hospitals included Royal Albert Edward Infirmary, Wrightington, and Wigan.

The article reviewed more than 10 articles on the subject

Methods: Intervention/Instruments

Chart review was used to get data relating to background comorbidities, sex, age, length of hospital stay, microorganisms isolated in urine, length of stay, and treatment given.

The study collected data from different articles addressing the pathogens and microorganisms causing UTI, the symptoms, and prevention measures

Intervention included collecting urine samples from the patients which were then measured against the UTI baseline measurements.

Intervention included searching through the Ovid (pSYCinfo, Medline, and Embase) addressing UTI among women.

Analysis

The authors used multivariate analysis to synthesize the data

The data was analyzed using thematic coding: adherence and colonization, other virulence factors, and combination therapies.

The data collected was used to create guideline flow charts and posters.

Analysis also involved comparing the baseline results with the final cycle

The peer-reviewed journals were analyzed by considering those that only address UTI patients who are 65 years and above and are females.

Key Findings

More than 29% of the cases received IEAT.

IEAT was associated with previous antibiotic, urinary catheter, and previous hospitalization

A significant finding is that there combination therapy can aid in the control of UTI.

Adhesins like UPEC and FimH have also been proven to be effective.

19 patients were diagnosed with UTI. After implementing the right strategies, the authors found that there was an improvement in diagnosis. 86.7% of the UTI cases were also correctly treated. The mean time for diagnosis also improved to 0 days.

One of the key findings is that asymptomatic bacteriuria is transient among the older women. The diagnosis of the disease can be done with both laboratory evidence and clinical features. The identified risk factors included functional disability, diabetes, urinary retention, and recent sexual intercourse.

Recommendations

There is need of improving empirical antimicrobial therapy could have a favorable impact on prognosis

There is a need to identify other potential therapies including vaccines, pilicides, and mannosides.

With a challenge of obtaining comprehensive history of UTI diagnosis, a key recommendation is to improve proforma by including the behavioral and mental state of patients during submission.

It is important to differentiate between asymptomatic and symptomatic UTI.

Explanation of How the Article Supports EBP/Capstone Project

The article discusses the effect of a treatment measure, IEAT, on elderly patients with UTI which is a key subject of the study.

The article addresses the various aspects of UTI among the elderly. This targets the subject research question.

Since the article addresses the key management measures of UTI among the elderly, it helps in addressing the study objective.

The article provides an overview of UTI, the symptom, and treatment options for elderly patients. It, thus, provide more information for the study.

The a

Criteria

Article 5

Article 6

Article 7

Article 8

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Rowe, T. A., & Juthani-Mehta

Aging health journal

doi: 10.2217/ahe.13.38

Beveridge, L. A., Davey, P. G., Phillips, G., & McMurdo

Dove medical Press Journal

http://doi.org/10.2147/CIA.S13423

Cove‐Smith, A. N. D. R. E. A., & Almond

Wiley Online Library

http://onlinelibrary.wiley.com/doi/10.1002/tre.33/pdf

Juthani-Mehta

American Society of Nephrology

https://www.asn-online.org/education/distancelearning/curricula/geriatrics/Chapter32.pdf

Article Title and Year Published

Urinary tract infection in older adults.

2013

Optimal management of urinary tract infections in older people

2011

Management of urinary tract infections in the elderly

2007

Urinary tract infections in elderly persons

2009

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

Research Question: What is the difference between UTI and ASB?

Purpose: To review the management of asymptomatic bacteriuria and symptomatic UTI among the elderly.

Hypothesis: the existing antimicrobial prescription guidelines have broad spectrum, thus, resulting in wrong treatment and diagnosis.

Purpose: to assess whether the existing antimicrobial agents are effective in treating UTI.

Purpose: to assess the microbial causes, symptoms, treatment, and prevention of UTI

Hypothesis: there are various short term and long term adverse outcomes of ASB

Purpose: to assess the outcomes of ASB among the older adults.

Design (Type of Quantitative, or Type of Qualitative)

Qualitative study: reviewing literature of UTI management among elderly women.

Qualitative study: reviewing literature of UTI management among elderly women.

Qualitative study: reviewing literature of UTI management among elderly women.

Qualitative study: administering interview questions

Setting/Sample

Different articles on the subject of UTI were reviewed for analysis

Different articles on the subject of UTI diagnosis and antimicrobial treatment were reviewed for analysis

15 articles on the subject of UTI causes, diagnosis and treatment were reviewed for analysis

20 articles on the subject of UTI causes, diagnosis and treatment were reviewed for analysis

Methods: Intervention/Instruments

Intervention included searching through the Ovid (pSYCinfo, Medline, and Embase) addressing UTI among women.

Intervention included searching through the past studies that address UTI treatment and prevention.

Intervention included searching through the past studies that address UTI treatment and prevention.

Questions were administered among the elderly patients and healthcare providers

Analysis

The peer-reviewed journals were analyzed by considering those that only address UTI patients who are 65 years and above and are females.

The peer-reviewed journals were analyzed by considering those that only address UTI elderly patients.

The 15 peer-reviewed journals were analyzed by considering those that only address UTI elderly patients

The results from the interview were compared with the data collected from the articles.

Key Findings

Findings reveal that both UTI and ASB are treatable, but there is a problem of antibiotic overutilization.

It was also revealed that distinguishing the types of UTI is challenging among elderly patients

It was found that UTI is always overdiagnosed and overtreated. The study also found that asymptomatic bacteriuria is common among the elderly

The prevalence of UTI increases with increasing age, thus, common among the elderly.

Prevention is important since most treating agents are ineffective

The prevalence of UTI increases with increasing age, thus, common among the elderly.

Nitrofurantoin is considered the most effective therapy for UTI patients.

Recommendations

There is need to develop evidence-based approach towards UTI diagnosis.

Recommendations include narrowing spectrum antibiotics in order to treat UTI.

It is important to investigate UTI elderly patients with diabetes mellitus.

Further analysis of the cranberry capsule use should be reviewed.

Explanation of How the Article Supports EBP/Capstone

By addressing the different types of UTI among the elderly patients, the article aids in conducting the study.

The study addresses the management techniques to control UTI among the elderly which is significant for the study.

The study focuses on the causes, symptoms, treatment, and prevention of UTI among the elderly. This is relevant to the study.

By addressing the different types of UTI among the elderly patients, the article aids in conducting the study.