Here is the standardised PICO analysis for the forty-ninth uploaded article:
Full Title
Quality of the Diagnostic Process, Treatment Decision, and Predictors for Antibiotic Use in General Practice for Nursing Home Residents with Suspected Urinary Tract Infection
Authors: Stine Dyhl Sommer-Larsen, Sif Helene Arnold, Anne Holm, Julie Aamand Olesen, Gloria Cordoba
Journal: Antibiotics, 2021; 10(3):316
DOI: 10.3390/antibiotics10030316
Type of Study
Prospective observational study conducted in general practice settings in Denmark
PICO Summary
Population (P)
- Nursing home residents aged ≥65 years in the Capital Region of Denmark
- Patients with suspected urinary tract infection (UTI) and no indwelling catheter
- N = 490 patients; 83% female, mean age ~85 years; 53% with dementia
Intervention (I)
- Assessment of diagnostic quality and treatment decisions made by general practitioners (GPs) on the first day of contact (Day 1)
- Involved processes such as:
- Symptom documentation
- Urine dipstick or culture testing
- Antibiotic prescribing decisions
- Communication mode (phone, face-to-face, email)
Comparison (C)
- Patients with vs. without urinary tract symptoms
- Use vs. non-use of diagnostic tools (e.g., urine culture at general practice or microbiology lab)
Outcomes (O)
Primary outcomes (Quality indicators):
- Only 40% of patients diagnosed with UTI had any urinary tract symptoms
- 91.2% of patients without urinary tract symptoms had a urine culture performed
- 26.3% of patients without urinary tract symptoms were prescribed antibiotics on Day 1
Predictors of antibiotic use on Day 1:
- Urine culture at general practice was associated with reduced likelihood of antibiotic prescribing (OR 0.27; 95% CI 0.13–0.56)
- Other predictors such as symptoms or demographics were not significantly associated with antibiotic prescribing
Findings Summary
This study highlights significant overdiagnosis and inappropriate antibiotic prescribing for UTIs in Danish nursing home residents:
- A large proportion of residents diagnosed with UTI had no specific urinary symptoms
- Urine cultures were often ordered inappropriately, especially for asymptomatic patients
- GPs frequently prescribed antibiotics without clinical justification, though those who used in-house urine culture testing were less likely to prescribe antibiotics on Day 1
The findings call for:
- Improved adherence to diagnostic guidelines
- Reduction in the use of urine culture as a reflex for non-specific symptoms
- Implementation of antibiotic stewardship programmes in general practice and aged care settings
Conclusion
Despite a relatively low antibiotic prescription rate on Day 1, the quality of diagnostic processes was poor, with overuse of urine cultures and mislabelling of UTI in asymptomatic patients. The study recommends targeted interventions to reduce unnecessary diagnostics and antibiotic prescribing for frail older adults in nursing homes .
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