Antibiotic Stewardship Program Allowed Lapsed UTI Treatment
Penalty
Summary
The deficiency involves the facility’s antibiotic stewardship program allowing lapsed or interrupted antibiotic therapy for a resident with a confirmed urinary tract infection (UTI). Facility policy on Antibiotic Stewardship requires that when a culture and sensitivity (C&S) is ordered, it will be completed and the lab results and current clinical situation will be communicated to the prescriber as soon as available to determine if antibiotic therapy should be started, continued, modified, or discontinued. National Institute of Health resources cited in the report state that lapsed or missed doses, particularly early in treatment, reduce treatment efficacy and allow for development of drug resistance, and FDA recommendations indicate that treatment for Proteus mirabilis complicated UTIs should be 500 mg of ciprofloxacin twice daily for 7 days. Despite these standards, the facility’s practice, as described by the Infection Control Preventionist (ICP), is that residents under this provider’s care are usually treated for only 3 days with antibiotics for a UTI with a positive culture, with discontinuation if a RN assessment finds no symptoms, and possible later restart if symptoms recur at the provider’s next visit. Resident 60 had diagnoses including Parkinson’s disease with dyskinesia and urinary retention, and a UTI confirmed by culture on November 28, 2025, showing >100,000 CFU/ml Proteus mirabilis. On that date, the provider ordered ciprofloxacin 250 mg by mouth twice daily for 3 days, and the resident received doses from the evening of November 28 through the morning of December 1, when the antibiotic was stopped per the initial order after the provider’s designated RN reported the resident had no UTI symptoms. The resident was then seen again on December 3, when suprapubic tenderness was noted on physical assessment, and the provider ordered a new course of ciprofloxacin 500 mg twice daily for 7 days for a complicated UTI. The Nursing Home Administrator stated that antibiotic usage is referred to the provider. The surveyors concluded that this pattern of short-course treatment with potential interruption and later restart, in the context of a confirmed Proteus mirabilis UTI and cited national guidance, demonstrated that the facility’s antibiotic stewardship program allowed for lapsed doses of antibiotic usage.
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