• Mark Loeb, Kevin Brazil, Lynne Lohfeld, Allison McGeer, Andrew Simor, Kurt Stevenson, Dick Zoutman, Stephanie Smith, Xiwu Liu, and Stephen D Walter.
• Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. loebm@mcmaster.ca
• BMJ. 2005 Sep 24; 331 (7518): 669.

ObjectiveTo assess whether a multifaceted intervention can reduce the number of prescriptions for antimicrobials for suspected urinary tract infections in residents of nursing homes.DesignCluster randomised controlled trial.Setting24 nursing homes in Ontario, Canada, and Idaho, United States.Participants12 nursing homes allocated to a multifaceted intervention and 12 allocated to usual care. Outcomes were measured in 4217 residents.InterventionsDiagnostic and treatment algorithm for urinary tract infections implemented at the nursing home level using a multifaceted approach--small group interactive sessions for nurses, videotapes, written material, outreach visits, and one on one interviews with physicians.Main Outcome MeasuresNumber of antimicrobials prescribed for suspected urinary tract infections, total use of antimicrobials, admissions to hospital, and deaths.ResultsFewer courses of antimicrobials for suspected urinary tract infections per 1000 resident days were prescribed in the intervention nursing homes than in the usual care homes (1.17 v 1.59 courses; weighted mean difference -0.49, 95% confidence intervals -0.93 to -0.06). Antimicrobials for suspected urinary tract infection represented 28.4% of all courses of drugs prescribed in the intervention nursing homes compared with 38.6% prescribed in the usual care homes (weighted mean difference -9.6%, -16.9% to -2.4%). The difference in total antimicrobial use per 1000 resident days between intervention and usual care groups was not significantly different (3.52 v 3.93; weighted mean difference -0.37, -1.17 to 0.44). No significant difference was found in admissions to hospital or mortality between the study arms.ConclusionA multifaceted intervention using algorithms can reduce the number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes.

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