Antimicrobial use in post-acute care: A retrospective descriptive analysis in seven long-term care facilities in Georgia

Richards, Chesley L.; Darradji, Mounir; Weinberg, Andrew D.; Ouslander, Joseph G.

doi:10.1016/j.jamda.2004.12.021

Cited by 26 publications

(18 citation statements)

References 13 publications

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“…This study found a substantial proportion (50%) of antibiotics prescribed for a suspected UTI was given to asymptomatic residents. Our results were also consistent with previous research that identified fluoroquinolones as the most common type of antibiotic used to treat UTIs [37,43]. …”

Section: Discussionsupporting

confidence: 93%

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Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes

et al. 2012

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BackgroundUrinary tract infections (UTIs) are the most commonly treated infection among nursing home residents. Even in the absence of specific (e.g., dysuria) or non-specific (e.g., fever) signs or symptoms, residents frequently receive an antibiotic for a suspected infection. This research investigates factors associated with the use of antibiotics to treat asymptomatic bacteriuria (ASB) among nursing home residents.MethodsThis was a cross-sectional study involving multi-level multivariate analyses of antibiotic prescription data for residents in four nursing homes in central Texas. Participants included all nursing home residents in these homes who, over a six-month period, received an antibiotic for a suspected UTI. We investigated what factors affected the likelihood that a resident receiving an antibiotic for a suspected UTI was asymptomatic.ResultsThe most powerful predictor of antibiotic treatment for ASB was the presence of an indwelling urinary catheter. Over 80 percent of antibiotic prescriptions written for catheterized individuals were written for individuals with ASB. For those without a catheter, record reviews identified 204 antibiotic prescriptions among 151 residents treated for a suspected UTI. Almost 50% of these prescriptions were for residents with no documented UTI symptoms. Almost three-quarters of these antibiotics were ordered after laboratory results were available to clinicians. Multivariate analyses indicated that resident characteristics did not affect the likelihood that an antibiotic was prescribed for ASB. The only statistically significant factor was the identity of the nursing home in which a resident resided.ConclusionsWe confirm the findings of earlier research indicating frequent use of antibiotics for ASB in nursing homes, especially for residents with urinary catheters. In this sample of nursing home residents, half of the antibiotic prescriptions for a suspected UTI in residents without catheters occurred with no documented signs or symptoms of a UTI. Urine studies were performed in almost all suspected UTI cases in which an antibiotic was prescribed. Efforts to improve antibiotic stewardship in nursing homes must address clinical decision-making solely on the basis of diagnostic testing in the absence of signs or symptoms of a UTI.

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Section: Discussionsupporting

confidence: 93%

“…One of the major issues in antibiotic stewardship in nursing homes is the use of antibiotics to treat suspected UTIs [37-40]. Despite extensive research demonstrating a lack of benefit and a potential for harm for antibiotic use for ASB [9,18,41], this practice continues to be prevalent among clinicians serving nursing home residents [2,42].…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes

et al. 2012

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“…Postacute facilities that provide skilled nursing and medical care (e.g., IV medications, wound care) have been shown to have substantially higher rates of antimicrobial prescribing than other types of nursing homes. 6 In the current study, strong risk factors for antimicrobial use included exposure to urinary catheters, clinically complex or extensive medical or rehabilitation services, and shortterm discharge potential. The latter finding suggests that postacute residents may be responsible for a disproportionate amount of antimicrobial exposure.…”

Section: Discussionmentioning

confidence: 98%

“…2 Although there are no national data on antimicrobial use and antimicrobial resistance in nursing homes, the few studies that have been published suggest that antimicrobial use ranges from 4 to 7 courses/1,000 resident-days in traditional nursing home populations [3][4][5] and as high as 29 antimicrobial courses/ 1,000 resident-days in facilities providing postacute care. 6 This translates into 2 to 4 million courses of antimicrobials in nursing homes each year and makes up approximately 40% of all systemic drugs prescribed in that setting. Depending on study definitions, between 25% and 75% of antimicrobials prescribed in nursing homes are considered inappropriate.…”

mentioning

confidence: 99%

Factors Associated with Antimicrobial Use in Nursing Homes: A Multilevel Model

Benoit

Nsa

Richards

et al. 2008

J American Geriatrics Society

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“…In addition to higher device utilization, these residents are more likely to receive antimicrobial therapy than long-stay LTCF residents. 15 Much remains to be learned about resident and LTCF factors correlated with HAIs. There is evidence that institutional factors such as nurse turnover, staffing levels, prevalence of Medicare recipients, rates of hospital transfer for infection, intensity of medical services, and family visitation rates are associated with incidence of HAI in the LTC setting.…”

Section: Infections In the Long-term Care Facility Epidemiologymentioning

confidence: 99%

SHEA/APIC Guideline: Infection prevention and control in the long-term care facility

Smith

Bennett²,

Bradley

et al. 2008

American Journal of Infection Control

200

132

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Antimicrobial use in post-acute care: A retrospective descriptive analysis in seven long-term care facilities in Georgia

Cited by 26 publications

References 13 publications

Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes

Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes

Factors Associated with Antimicrobial Use in Nursing Homes: A Multilevel Model

SHEA/APIC Guideline: Infection prevention and control in the long-term care facility

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