A Multifaceted Antimicrobial Stewardship Program for the Treatment of Uncomplicated Cystitis in Nursing Home Residents.

Importance: Urinary tract infections are the most common infections in nursing home residents. However, most antibiotic use is for unlikely cystitis (ie, nonspecific symptoms and positive culture results secondary to asymptomatic bacteriuria or a urine sample improperly collected for culture) that is unnecessary and inappropriate. This antibiotic use is associated with an increased risk of antimicrobial resistance, adverse drug events, and Clostridioides difficile (formerly Clostridium difficile) infections.

The IOU Consensus Recommendations for Empirical Therapy of Cystitis in Nursing Home Residents.

Objective: To establish consensus recommendations for empirical treatment of uncomplicated cystitis with anti-infectives in noncatheterized older nursing home residents to be implemented in the Improving Outcomes of UTI Management in Long-Term Care Project (IOU) funded by the Agency for Healthcare Research and Quality.

Design: Two-round modified Delphi survey.

Participants: Expert panel of 19 clinical pharmacists.

The Improving Outcomes of UTI Management in Long-Term Care Project (IOU) Consensus Guidelines for the Diagnosis of Uncomplicated Cystitis in Nursing Home Residents.

Objectives: To identify a set of signs and symptoms most likely to indicate uncomplicated cystitis in noncatheterized nursing home residents ≥65 years of age using consensus-based methods informed by a literature review.

Design: Literature review and modified Delphi survey with strict inclusion criteria.

Setting And Participants: Expert panel of 20 physicians certified in geriatric medicine and/or medical direction, actively practicing in post-acute and long-term care settings.

The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure.

Objectives: Nonspecific signs and symptoms combined with positive urinalysis results frequently trigger antibiotic therapy in frail older adults. However, there is limited evidence about which signs and symptoms indicate urinary tract infection (UTI) in this population. We aimed to find consensus among an international expert panel on which signs and symptoms, commonly attributed to UTI, should and should not lead to antibiotic prescribing in frail older adults, and to integrate these findings into a decision tool for the empiric treatment of suspected UTI in this population.

Pneumococcal Vaccination Guidance for Post-Acute and Long-Term Care Settings: Recommendations From AMDA's Infection Advisory Committee.

Efforts at preventing pneumococcal disease are a national health priority, particularly in older adults and especially in post-acute and long-term care settings The Advisory Committee on Immunization Practices recommends that all adults ≥65 years of age, as well as adults 18-64 years of age with specific risk factors, receive both the recently introduced polysaccharide-protein conjugate vaccine against 13 pneumococcal serotypes as well as the polysaccharide vaccine against 23 pneumococcal serotypes. Nursing facility licensure regulations require facilities to assess the pneumococcal vaccination status of each resident, provide education regarding pneumococcal vaccination, and administer the appropriate pneumococcal vaccine when indicated. Sorting out the indications and timing for 13 pneumococcal serotypes and 23 pneumococcal serotypes administration is complex and presents a significant challenge to healthcare providers.

Clinical uncertainties in the approach to long term care residents with possible urinary tract infection.

Urinary tract infection (UTI) is arguably the most common infection in the long term care (LTC) setting. Making the diagnosis of UTI and deciding when to initiate treatment with antimicrobial therapy is a challenge to all LTC providers. Widespread prevalence of asymptomatic bacteriuria, lack of an accepted clinical or laboratory gold standard to start antibiotics for UTI, and a high prevalence of cognitive impairment in the LTC population all contribute to this challenge.

Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria.

(See the commentary by Moro, on pages 978-980 .) Infection surveillance definitions for long-term care facilities (ie, the McGeer Criteria) have not been updated since 1991. An expert consensus panel modified these definitions on the basis of a structured review of the literature.

Determinants of parathyroid hormone levels in nursing home residents.

Introduction: Elevated parathyroid hormone (PTH) levels contribute to age-related bone loss. Practitioners should be aware of iatrogenic and/or correctable determinants of PTH elevation.

Methods: We performed a cross-sectional study including 302 of 609 eligible residents at a state veterans home.

Emergence of rimantadine-resistant virus within 6 days of starting rimantadine prophylaxis with oseltamivir treatment of symptomatic cases.

Objectives: To report on the detection of rimantadine resistance within 6 days of starting rimantadine prophylaxis.

Design: Observational prospective study.

Setting: Fifty-bed nursing unit during the 2004/05 influenza season.

Determinants of vitamin D levels in nursing home residents.

Objective: To determine the effect of various doses of vitamin D(2) and D(3), as well as ambulatory status (a surrogate for sun exposure), on 25-OH-D levels.

Design: Cross-sectional study with multiple regression analysis.

Setting: A state veterans home for veterans and their spouses.