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 institutiona lized elderly people has not been shown to be of benefit and may in fact be harmful; however, antibiotics are still frequently used to treat asymptoma tic bacteriuria in this population. The aim of this study was to explore th e perceptions, attitudes and opinions of physicians' and nurses involved in the process of prescribing antibiotics for asymptomatic bacteriuria in ins titutionalized elderly people. Methods: Focus groups were conducted among physicians and nurses who provid e care to residents of long-term care facilities in Hamilton, Ont. A total of 22 physicians and 16 nurses participated. The focus group discussions we re tape-recorded, and the transcripts of each session were analysed for iss ues and themes emerging from the text. Content analysis using an open analy tic approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to th e relevant and emergent themes and issues. Results: We observed that the ordering of urine cultures and the prescribin g of antibiotics for residents with asymptomatic bacteriuria were influence d by a wide range of nonspecific symptoms or signs in residents. The physic ians felt that the presence of these signs justified a decision to order an tibiotics. Nurses played a central role in both the ordering of urine cultu res and the decision to prescribe antibiotics through their awareness of ch anges in residents' status and communication of this to physicians. Educati on about asymptomatic bacteriuria was viewed as an important priority for b oth physicians and nurses. Interpretation: The presence of nonurinary symptoms and signs is an importa nt factor in the prescription of antibiotics for asymptomatic bacteriuria i n institutionalized elderly people. However, no evidence exists to support this reason for antibiotic treatment. Health care providers at long-term ca re facilities need more education about antibiotic use and asymptomatic bac teriuria.