{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T17:15:17Z","timestamp":1787246117207,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,3,28]],"date-time":"2017-03-28T00:00:00Z","timestamp":1490659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R18 HS022846\u201001"],"award-info":[{"award-number":["R18 HS022846\u201001"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (\n                      <jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content>\n                      s) in nursing home (\n                      <jats:styled-content style=\"fixed-case\">NH<\/jats:styled-content>\n                      ) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Chart\u00a0review of 260 randomly\u2010selected cases from 247\n                      <jats:styled-content style=\"fixed-case\">NH<\/jats:styled-content>\n                      residents treated with an antibiotic for a presumed\n                      <jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content>\n                      in 31\n                      <jats:styled-content style=\"fixed-case\">NH<\/jats:styled-content>\n                      s in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work\u2010up and subsequent clinical events including emergency department use, hospitalization, and death. Analyses described the decision\u2010making processes and outcomes and compared decisions made with Loeb criteria for initiation of antibiotics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 260 cases, 60% had documented signs\/symptoms of the presenting illness and 15% met the Loeb criteria. Acute mental status change was the most commonly documented sign\/symptom (24%).\n                      <jats:styled-content style=\"fixed-case\">NH<\/jats:styled-content>\n                      providers (81%) were the most common prescribers and ciprofloxacin (32%) was the most commonly prescribed antibiotic. Fourteen percent of presumed\n                      <jats:styled-content style=\"fixed-case\">UTI<\/jats:styled-content>\n                      cases included a white blood cell count, 71% included a urinalysis, and 72% had a urine culture. Seventy\u2010five percent of cultures grew at least one organism with \u2265100,000 colony\u2010forming units\/milliliter and 12% grew multi\u2010drug resistant organisms; 28% of antibiotics were prescribed for more than 7\u00a0days, and 7% of cases had a subsequent death, emergency department visit, or hospitalization within 7\u00a0days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Non\u2010specific signs\/symptoms appeared to influence prescribing more often than urinary tract\u2010specific signs\/symptoms. Prescribers rarely stopped antibiotics, and a minority prescribed for overly long periods. Providers may need additional support to guide the decision\u2010making process to reduce antibiotic overuse and antibiotic resistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.14857","type":"journal-article","created":{"date-parts":[[2017,3,28]],"date-time":"2017-03-28T13:37:08Z","timestamp":1490708228000},"page":"1719-1725","source":"Crossref","is-referenced-by-count":32,"title":["The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents"],"prefix":"10.1111","volume":"65","author":[{"given":"Christine E.","family":"Kistler","sequence":"first","affiliation":[{"name":"Department of Family Medicine School of Medicine University of North Carolina Chapel Hill North Carolina"},{"name":"Cecil G. 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