Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people?: A qualitative study of physicians' and nurses' perceptions

BACKGROUND: Antibiotic therapy for asymptomatic bacteriuria in institutionalized elderly people has not been shown to be of benefit and may in fact be harmful; however, antibiotics are still frequently used to treat asymptomatic bacteriuria in this population. The aim of this study was to explore the perceptions, attitudes and opinions of physicians and nurses involved in the process of prescribing antibiotics for asymptomatic bacteriuria in institutionalized elderly people. METHODS: Focus groups were conducted among physicians and nurses who provide care to residents of long-term care facilities in Hamilton, Ont. A total of 22 physicians and 16 nurses participated. The focus group discussions were tape-recorded, and the transcripts of each session were analysed for issues and themes emerging from the text. Content analysis using an open analytic approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent themes and issues. RESULTS: We observed that the ordering of urine cultures and the prescribing of antibiotics for residents with asymptomatic bacteriuria were influenced by a wide range of nonspecific symptoms or signs in residents. The physicians felt that the presence of these signs justified a decision to order antibiotics. Nurses played a central role in both the ordering of urine cultures and the decision to prescribe antibiotics through their awareness of changes in residents' status and communication of this to physicians. Education about asymptomatic bacteriuria was viewed as an important priority for both physicians and nurses. INTERPRETATION: The presence of nonurinary symptoms and signs is an important factor in the prescription of antibiotics for asymptomatic bacteriuria in institutionalized elderly people. However, no evidence exists to support this reason for antibiotic treatment. Health care providers at long-term care facilities need more education about antibiotic use and asymptomatic bacteriuri

【研究背景】针对机构照护老年人群的无症状菌尿症（asymptomatic bacteriuria）开展抗生素治疗，不仅未被证实具有临床获益，反而可能带来危害；但临床实践中，仍常将抗生素用于该人群的无症状菌尿症治疗。本研究旨在探索参与机构照护老年患者无症状菌尿症抗生素处方流程的医师与护士的认知、态度及看法。
【研究方法】本研究于安大略省汉密尔顿市的长期护理机构（long-term care facilities）中，面向照护机构入住者的医护人员开展焦点小组访谈（focus groups）。共计22名医师及16名护士参与本次研究。焦点小组讨论全程录音，随后对每场讨论的转录文本进行分析，以挖掘文本中浮现的问题与主题。本研究采用开放式分析方法开展内容分析，以探索并理解焦点小组参与者的实际体验；之后根据文本中相关且新浮现的主题与问题，对数据进行编码。
【研究结果】本研究发现，针对无症状菌尿症入住者开具尿液培养与抗生素处方的行为，会受到入住者多种非特异性症状或体征的影响。医师认为，此类体征的存在可作为开具抗生素的合理依据。护士通过监测入住者的状态变化并向医师汇报，在尿液培养开具及抗生素处方决策中均发挥了核心作用。医师与护士均认为，无症状菌尿症相关知识培训是二者的重要优先事项。
【研究阐释】对于机构照护老年人群的无症状菌尿症而言，非泌尿系统症状与体征是抗生素处方的重要影响因素。但目前尚无证据支持将此类因素作为抗生素治疗的依据。长期护理机构的医疗服务提供者需要接受更多关于抗生素使用与无症状菌尿症的相关培训。