Study at VA community living centers suggests positive results from antibiotic stewardship

A VA study has documented a drop in the use of antibiotics to treat urinary tract infections at VA community living centers. (Photo: ©iStock/StockPlanets)

A new study found a significant drop between 2013 and 2017 in antibiotic use at VA community living centers treating older Veterans with urinary tract infections. The researchers see this as a positive sign in VA-wide efforts to stem the improper use of antibiotics.

The findings appeared in the journal Infection Control & Hospital Epidemiology in July 2019.

“Antibiotic stewardship efforts across VA community living centers should be applauded and should continue to be an ongoing effort,” the researchers write. “Antibiotic stewardship can be used to reduce inappropriate use of antibiotics and ultimately improve the care of residents with UTIs.” Antibiotic stewardship also refers to efforts to promote the right antibiotic, dose, and duration of use.

Dr. Haley Appaneal, a clinician scientist at the Providence VA Medical Center in Rhode Island, led the study. With expertise in infectious diseases, antibiotic stewardship, and pharmacy practice, she’s interested in improving the quality of Veteran care at community living centers through a reduction in inappropriate antibiotic use. These facilities, similar to nursing homes, provide services to Veterans who need a medically skilled environment for short- and long-term stays.

The findings in the study are important, Appaneal says, because antibiotics are among the most commonly used drugs at all VA and non-VA long-term care facilities, they are often used for urinary tract infections, and they are often used the wrong way.

“All antibiotic use, both appropriate and inappropriate, can lead to problems,” says Appaneal, who is also an adjunct assistant professor at the University of Rhode Island. “However, when antibiotics are used inappropriately, they may cause more harm than good. Problems that antibiotics can lead to include adverse drug effects, allergic reactions, serious diarrhea due to a bacteria known as Clostridium difficile or C. diff, hospitalizations, and an increased risk of infections because of bacteria that resist the effects of antibiotics and are harder to treat.”

“Antibiotic stewardship efforts across VA community living centers should be applauded and should continue to be an ongoing effort.”

Antibiotics are the most effective drugs to treat urinary tract infections, which are caused by bacteria in parts of the urinary tract, including the urethra, bladder and kidneys. When someone also has symptoms of an infection, such as pain or burning when urinating or the need to urinate more often, antibiotics are needed to kill the bacteria and treat the infection.

The problem is that antibiotics are often not used correctly for UTIs, Appaneal says.

The two main ways antibiotics can be used the wrong way, she explains, are when they aren’t needed and when they are needed but not used correctly. One of the major problems with UTIs is that antibiotics are frequently used unnecessarily—for example, when patients have no symptoms of a UTI but have bacteria in their urine. It’s common for older people to have bacteria in their urine without UTI symptoms, and in most cases treating these patients with antibiotics doesn’t help them live better or longer, she notes.

“Older residents often have bacteria in their urine without any signs or symptoms of infection, a condition that’s different from a urinary tract infection and is called asymptomatic bacteriuria,” Appaneal says. “Antibiotics generally are not needed when residents don’t have signs or symptoms of an infection. That’s when antibiotics can cause more harm than good.”

Using the electronic health record, her team identified all episodes of UTIs among residents at 110 VA community living centers from 2013 to 2017. There were nearly 30,000 episodes involving some 15,000 Veterans.

The total rate of antibiotic use per 1,000 bed days of care declined 10% per year among UTI episodes. The use of fluoroquinolones, a class of antibiotics that can be especially problematic, dropped by 15% per year.

To read more about the study, visit VA Research Currents.