F0881

D

Failure to Implement Antibiotic Stewardship and Apply McGeer’s Criteria for UTI Management

Chillicothe, Ohio Survey Completed on 02-26-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to implement its antibiotic stewardship policy and McGeer’s criteria when monitoring and managing antibiotic use for residents with suspected urinary tract infections (UTIs). For one resident with malignant neoplasm of the urethra, chronic kidney disease, obstructive and reflux uropathy, and an indwelling catheter, the catheter was accidentally dislodged and replaced in the emergency room, where a urinalysis showed blood and leukocytes and the resident was diagnosed with a UTI. She was started on Cefuroxime, which was continued despite the resident denying dysuria, fever, flank pain, chest pain, or dyspnea, and despite a subsequent urine culture showing pseudomonas aeruginosa at levels below McGeer’s threshold and without Cefuroxime listed as an effective antibiotic. The facility’s antibiotic stewardship evaluation documented that McGeer’s criteria were not met but still recorded a physician justification that did not specify which physician provided it or what symptoms were present.

For a second resident with diabetes, chronic kidney disease, and an indwelling catheter, an admission order was written for Keflex for a UTI. The facility’s antibiotic stewardship evaluation stated that the resident had a UTI with onset that day, was not experiencing pain related to the infection, and had repeated oral temperatures of 99°F, and concluded that McGeer’s criteria were met based on fevers and a urine culture with at least 10^5 CFU/mL. The urine culture later showed >100,000 CFU/mL of proteus mirabilis, but the sensitivity report did not include Keflex, and facility documentation noted that Keflex’s effectiveness for UTIs depends on local resistance patterns and that culture and sensitivity testing is crucial before prescribing. Keflex was administered until it was discontinued early due to diarrhea, and there was no evidence that the physician reviewed the continued use of Keflex when it was not listed on the sensitivity report. The DON later stated that the stewardship evaluation was marked in error, as the resident had only one slightly elevated temperature and not repeated fevers.

For a third resident with diabetes and hypertension, who had a catheter and was sent to the emergency room for decreased urinary output and concern for kidney injury, hospital records documented burning urinary pain but also noted denial of abdominal or flank discomfort, fevers, chills, hematuria, or dysuria. The resident was started on Macrobid for a UTI and completed a five-day course, and a physician progress note indicated the plan to continue Macrobid and follow up on urine culture results to ensure appropriate coverage. The subsequent urine culture showed 10,000–50,000 CFU/mL of pseudomonas aeruginosa and escherichia coli, which did not meet McGeer’s threshold of >100,000 CFU/mL, and there was no evidence of physician follow-up on the antibiotic choice in light of these results. The DON confirmed that an antibiotic stewardship evaluation was not completed for this antibiotic use and that the physician did not reassess the need for Macrobid when the culture results did not support antibiotic therapy, contrary to the facility’s policy requiring communication of culture and sensitivity results to determine whether antibiotics should be started, continued, modified, or discontinued.