F0881

E

Failure to Implement Effective UTI Antibiotic Stewardship and Symptom Monitoring

San Diego, California Survey Completed on 03-05-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to implement an effective infection prevention and antibiotic stewardship process for three residents with suspected or documented urinary tract infections (UTIs). For one resident with quadriplegia, immunodeficiency, and a suprapubic catheter, the facility used an Infection Screening Evaluation tool as part of its surveillance program. On 1/12/26, this resident’s screening showed a score of 50 with acute dysuria, and a urine culture from 1/9/26 showed Gram Positive Cocci with a colony count of 50,000–90,000. The physician ordered Macrobid from 1/9/26 through 1/16/26 for UTI treatment, but there was no supporting documentation that nursing staff monitored UTI symptoms or potential side effects during the antibiotic course.

For the same resident, an Infection Screening Evaluation completed on 2/11/26 showed a score of zero, indicating no symptoms of infection, yet the resident was prescribed Levofloxacin from 2/10/26 through 2/17/26 for UTI and Methenamine Hippurate for infection prophylaxis without a stop date. The Methenamine Hippurate order did not include a documented diagnosis supporting infection prophylaxis, and again there was no documentation of monitoring for UTI symptoms or side effects while the resident was on these antibiotics. The Infection Prevention (IP) nurse acknowledged that the resident should have been monitored for signs and symptoms of UTI during antibiotic therapy and that the prophylactic antibiotic order lacked a defined duration and clear diagnostic basis.

A second resident with Parkinson’s disease and moderate cognitive deficits complained of dysuria on 2/2/26 and had a urinalysis on 2/3/26 showing many bacteria. The resident, who was incontinent and did not have a urinary catheter, was prescribed Cefuroxime Axetil for seven days beginning 2/4/26 for a suspected UTI. However, the facility did not complete an Infection Screening Evaluation prior to starting the antibiotic to determine if McGeer criteria for UTI were met. During the antibiotic course, only one progress note dated 2/10/26 documented monitoring of UTI symptoms, stating the resident continued on antibiotics for UTI with no complaint of bladder discomfort, and no consistent monitoring of UTI symptoms was documented.

A third resident with diabetes mellitus and moderate cognitive deficits was prescribed Ciprofloxacin from 2/8/26 through 2/15/26 for a suspected UTI based on confusion and a urinalysis with a colony count greater than 100,000 E. coli. The IP nurse stated that, according to McGeer criteria, residents without an indwelling catheter must exhibit two or more clinical symptoms in addition to a positive culture to support a UTI diagnosis, and confusion alone did not meet the diagnostic criteria for initiating antibiotic therapy. For this resident, the Infection Screening Evaluation was not completed prior to starting antibiotics, and there was no documented monitoring of UTI symptoms while on treatment. Across all three residents, the facility’s documented practices did not align with its Antibiotic Stewardship policy, which required complete antibiotic orders including duration and the use of clinical criteria and evaluation tools before and during antibiotic therapy.