BackgroundAntibiotics are frequently prescribed in nursing homes (NH). National data describing facility-level antibiotic use (AU) in NH are lacking. The objectives of this analysis were to use NH electronic health records (EHR) to describe AU in NH and variability in AU rates across NH.MethodsWe analyzed antibiotic orders for 309,884 residents in 1,664 US NHs using one EHR company in 2016. We calculated AU rates as antibiotic days-of-therapy (DOT) per 1,000 resident-days and compared by the type of stay (short-stay (SS) ≤ 100 days vs. long-stay (LS) >100 days). We also examined prescribing indications and the duration of nursing home-initiated antibiotic orders. We assessed facility-level correlates of AU using resident health and NH facility characteristics publically available through NH Compare and LTCfocus using a univariate linear regression.ResultsIn 2016, 57% of NH residents received at least one systemic antibiotic; overall rate of AU was 90 DOT/1,000 resident-days. The median facility-level AU rate was 64 DOT/1,000 resident-days (IQR 36–104). The median proportion of SS residents at a facility was 74% (IQR 60–84%). The SS and LS AU rates were 241 DOT/1,000 resident-days (IQR 173–342) and 24 DOT/1,000 resident-days (IQR 14–37), respectively. Overall, the three most common antibiotic classes prescribed were fluoroquinolones (18%), cephalosporins (18%), and extended-spectrum β-lactams (10%). Antibiotics were most frequently prescribed for urinary tract infections, and the mean duration of an antibiotic order was 9 days (range 1–365). Higher facility AU rate correlated positively with the following facility characteristics; proportion of SS residents, urban location, proportion of residents with mild cognitive impairment and lower activities of daily living scores, presence of ventilator beds, proportion of LS residents with urinary catheters or pressure ulcers, facility case-mix index, and not-for-profit ownership and multiorganization facilities.ConclusionSignificant variability in NH AU rates exist, and SS residents have higher AU rates. Identifying NH with high rates of AU after adjusting for facility-level predictors of AU may identify opportunities for targeting efforts to improve prescribing practices.Disclosures All Authors: No reported Disclosures.
Objectives: Vaccine preventable diseases significantly lead to high under 5 mortality in sub-Saharan Africa. Much attention is given to immunization coverage, but little is known about the population of never-vaccinated children (those that have not received any dose of the WHO recommended immunizations) in Ethiopia. This study aims to (i) Describe the prevalence of never-vaccinated children in Ethiopia and (ii) Examine the effects of individual and contextual factors on non-vaccination of Ethiopian children. Methods: We conducted a secondary analysis using pooled cross-sectional data from 2000-2016 Ethiopia Demographic Health Survey. Analyses were restricted to children aged 12-59 months. A two-level multilevel regression analysis model was built with individuals (level 1) nested within communities (level 2). Results: A total of 20,212 children aged 12-59 months nested within 520 clusters were included in the analysis. Approximately 19% (n=3,943) of the study sample had never been vaccinated. Prevalence of non-vaccination was higher among mothers who delivered at home (86%), with no formal education (62%). In the fully adjusted model, the odds of not being vaccinated reduced for children whose mothers attended high school (adjusted odds ratio [aOR] = 0.35; 95% confidence interval [CI] =0.14-0.84), had employment (aOR, 0.74; 95% CI, 0.59-0.92) and delivered in the hospital (aOR, 0.68; 95% CI, 0.52-0.91). As wealth index increases, the odds of a child not being vaccinated decreased (aOR, 0.63; 95%CI, 0.42-0.93). The odds of being unvaccinated were higher among children whose mother lived in rural area (aOR, 1.76; 95% CI, 1.07-2.89), Somali region (aOR, 13.16; 95% CI, and Affar region (aOR, 8.28; 95% CI, 5.04-13.61) compare to those who lived in urban area or Addis Ababa. Conclusions: Both individual and contextual factors contributed to non-vaccination of children in Ethiopia. Interventions to improve childhood vaccination could benefit from putting these factors responsible for non-vaccination of under 5 children into consideration.
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