F0881

D

Failure to Follow McGeer Criteria in Antibiotic Stewardship

Marietta, Georgia Survey Completed on 02-18-2026

Penalty

No penalty information released

Summary

The facility failed to implement an effective Antibiotic Stewardship Program as required by its policy and nationally recognized infection surveillance criteria, specifically the McGeer criteria, when initiating antibiotics for two residents. For one resident, R92, who had vascular dementia with psychotic disturbance, delirium due to a known physiological condition, 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 that the urinalysis was positive for a urinary tract infection and ordered Nitrofurantoin 100 mg twice daily for seven days, which was administered as ordered.

However, the facility’s Antibiotic Stewardship Binder documented that R92 did not meet McGeer criteria for antibiotic initiation. The Revised McGeer Criteria for Infection Surveillance Checklist dated 1/8/2026 for this resident recorded increased confusion and visual hallucinations, and specifically indicated that urinary tract infection criteria were not met. Despite this, antibiotic therapy was started and completed. This showed that the decision to treat was made and carried out without adherence to the established McGeer criteria that the facility’s policy required for determining when to initiate antibiotics.

For another resident, R10, who had an indwelling urethral catheter and diagnoses including infection and inflammatory reaction due to an indwelling catheter, neuromuscular dysfunction of the bladder, urinary retention, acute cystitis without hematuria, Type 2 diabetes mellitus 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 ordered Ciprofloxacin 250 mg every 12 hours for five days for a urinary tract infection, and the medication was administered as ordered. The Revised McGeer Criteria Checklist for this resident documented foul smell, cloudy urine, and sediments, and indicated that urinary tract infection criteria were not met. The Antibiotic Stewardship Binder also documented that this resident did not meet McGeer criteria for antibiotic initiation. Interviews with the DON, NP, Administrator, and National Director of Risk Management confirmed that antibiotics were prescribed and administered when McGeer criteria were not met and that antibiotic stewardship practices, including antibiotic time-outs and accurate data tracking, were not being properly followed per facility policy.