Potentially Inappropriate Treatment of Urinary Tract Infections in Two Rhode Island Nursing Homes

casepatients(ie,urinalysisshowinginfection)metinclusion criteria. Antibiotic treatment was initiated in 96 of the 172 case patients (56%); 146 case patients (85%) did notmeettheMcGeercriteria,yetantibiotictreatmentwas initiated in 70 of these (41%). Furthermore, 69 case patients (72%) received an inappropriate drug based on InfectiousDiseasesSocietyofAmericancriteria,44casepatients(46%)receivedinappropriatedrugdosingbasedon creatinine clearance, and 64 case patients (67%) received treatmentforlongerthanrecommended.Patientswhodid notmeettheMcGeercriteriabutreceivedantibiotictherapy were 8.5 (95% confidence interval, 1.7-42.2) times more likely to develop C difficile within 3 months of treatment. Conclusion: Opportunities exist to improve provider practice related to the appropriate treatment of urinary tract infections in the nursing home. Arch Intern Med. 2011;171(5):438-443