Antibiotic Initiated Without Required Culture and Sensitivity Results
Penalty
Summary
The facility failed to follow its Antibiotic Stewardship Policy by initiating antibiotic therapy without culture and sensitivity results to guide treatment for one resident. The policy, revised on 6/16/25, stated the facility would improve antibiotic use through an Antibiotic Stewardship Program, utilize McGeer's Criteria to validate infections, and routinely review culture and sensitivity reports as part of infection surveillance. For urinary tract infections without an indwelling catheter, McGeer's Criteria require at least one clinical sign or symptom and at least one microbiologic criterion, including specific quantitative culture results. The facility's care plan for the resident, dated 12/29/25, directed staff to monitor, document, and report signs and symptoms of urinary tract infection to the provider as needed. The resident was admitted with multiple diagnoses including muscle weakness, lower back pain, and a need for assistance with personal care. A urine specimen was collected on 1/8/26, with the laboratory report indicating that a culture and sensitivity test would be completed. On 1/9/26, a nursing progress note documented that the provider was informed the urine was positive with bacteria and ordered Rocephin 1 gram intramuscularly for 7 days, while the facility was still waiting for the culture and sensitivity results. A subsequent laboratory report dated 1/14/26 documented that the culture and sensitivity was cancelled due to no sample to perform the test. On 2/20/26, the ADON confirmed that the provider ordered antibiotic therapy before culture and sensitivity results were available to determine appropriate therapy.
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