F0757

D

Failure to Follow Antibiotic Stewardship and McGeer Criteria for UTI Treatment

Marietta, Georgia Survey Completed on 02-18-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure residents’ drug regimens were free from unnecessary antibiotics, contrary to its Antibiotic Stewardship Program policy and use of McGeer criteria. For one resident (R92) with vascular dementia, delirium, urinary retention, cerebrovascular disease, metabolic encephalopathy, and major depressive disorder, a urinalysis with culture and sensitivity was ordered due to increased confusion and hallucinations. The practitioner documented a positive urinary tract infection (UTI) and ordered Nitrofurantoin 100 mg by mouth twice daily for seven days, which was administered from 1/13/2026 through 1/19/2026. However, the facility’s Antibiotic Stewardship Binder and the revised McGeer Criteria for Infection Surveillance Checklist dated 1/8/2026 documented that UTI criteria were not met, and that the resident did not meet McGeer criteria for antibiotic initiation.

For another resident (R10) with an indwelling catheter and diagnoses including infection and inflammatory reaction due to an indwelling urethral catheter, neuromuscular bladder dysfunction, urinary retention, acute cystitis without hematuria, Type 2 diabetes with hyperglycemia, unspecified psychosis, and recurrent major depressive disorder, staff documented cloudy, foul-smelling urine with sediment and notified the practitioner with a request for urine testing. The practitioner subsequently ordered Ciprofloxacin 250 mg by mouth every 12 hours for five days for a UTI, and the medication was administered from 1/20/2026 through 1/26/2026. The revised McGeer Criteria checklist for this resident, dated 1/13/2026, documented foul smell, cloudy urine, and sediments but indicated that UTI criteria were not met, and the Antibiotic Stewardship Binder recorded that McGeer criteria for antibiotic initiation were not met.

Interviews with the DON and NP II confirmed that antibiotics were prescribed and administered based on the clinical picture and positive urine culture results rather than adherence to McGeer criteria and the facility’s stewardship policy. The DON acknowledged that the facility had not been appropriately following antibiotic stewardship practices, had not been conducting antibiotic time-outs, and that the stewardship data tracking tool had not been properly implemented, resulting in inaccurate antibiotic stewardship data. The Administrator and National Director of Risk Management stated that providers were expected to follow McGeer criteria and acknowledged that the prescribing patterns in these cases did not meet the facility’s protocol.