Failure to Follow Antibiotic Stewardship and McGeer’s Criteria for UTI Treatment
Penalty
Summary
The deficiency involves failure to follow the facility’s Antibiotic Stewardship Policy and McGeer’s Criteria when initiating antibiotic therapy for a suspected urinary tract infection (UTI). The policy, revised 8/10/25, states the facility focuses on improving antibiotic use through an Antibiotic Stewardship Program, utilizes McGeer’s Criteria to validate infections, and routinely reviews culture and sensitivity reports as part of infection surveillance. McGeer’s Criteria for UTI without an indwelling catheter require at least one specified clinical sign or symptom and at least one qualifying microbiologic criterion. Despite these requirements, the facility initiated antibiotic treatment before culture and sensitivity results were available and in a situation later confirmed by the DON not to meet McGeer’s criteria for UTI. The resident involved was readmitted with multiple diagnoses, including history of falling, adult failure to thrive, and a need for assistance with personal care. The resident’s care plan, revised 3/27/25, directed staff to encourage fluids and monitor for specific urinary and systemic symptoms such as urinary frequency, malaise, foul-smelling urine, dysuria, fever, nausea, vomiting, flank pain, suprapubic pain, hematuria, cloudy urine, altered mental status, loss of appetite, and behavioral changes. On 3/27/25 at 4:43 PM, the resident was observed to be increasingly lethargic with decreased muscle function, and the provider was notified. New orders were obtained for a CBC, CMP, urinalysis with culture and sensitivity, and cefdinir 300 mg by mouth twice daily for 5 days for a diagnosis of UTI. The urine specimen was collected earlier that day, and the culture and sensitivity were not completed until 3/29/25, three days after antibiotics were started. On 3/5/26 at 4:12 PM, the DON confirmed the resident did not meet McGeer’s criteria for antibiotics for a UTI.
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