Antimicrobials in acute and long-term care: a point in time along the way to improved use

Neuhauser, Melinda M.; Weber, J. Todd

doi:10.2807/1560-7917.es.2018.23.46.1800607

Cited by 2 publications

(7 citation statements)

References 9 publications

(24 reference statements)

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“…Second, because the survey was performed within selected counties of the 10 EIP states that are largely urban, it is uncertain if the data are generalizable to other US nursing homes. However, the participating nursing homes were not found to be substantially different than those in the United States 21 as a whole, and selected resident-level characteristics are comparable with published CMS data on nursing home residents. 11 Third, the survey was based on data from 2017 and may not represent nursing homes in 2021.…”

Section: Limitationssupporting

confidence: 63%

“…Fourteen nursing homes that initially agreed to participate subsequently declined, leaving 161 that completed the prevalence survey. As reported elsewhere, 21 nursing homes that participated were similar to nursing homes nationally in CMS Nursing Home Compare, except that nursing homes included in the survey had more beds and residents and lower health inspection scores. There were 15 276 eligible residents in the 161 participating nursing homes.…”

Section: Nursing Homes and Residentsmentioning

confidence: 68%

“…These data confirm that prescribing for urinary tract infections is the leading indication for antimicrobial use in nursing home residents, accounting for 29% of overall use; a detailed description has been published elsewhere. 21 The other main indications for antimicrobial use were for skin and wound and respiratory tract infections. As reported elsewhere, 18,22 if the survey had been performed during winter months, antimicrobial use for respiratory tract infections would likely increase.…”

Section: Discussionmentioning

confidence: 99%

“…These 3 leading indications, representing the majority of antimicrobial use, mirror results reported from other countries. 15,[25][26][27][28][29] Monitoring and optimizing diagnostic and testing practices, in addition to antimicrobial use for these 3 indications, and specifically including urinary tract prophylaxis, which is mostly inappropriate, 15,21,25,30 should be a major focus of antimicrobial stewardship activities in nursing homes. Implementation of treatment guidelines for urinary tract infections that inform and standardize treatment decisions, like those from the Society of Post-Acute and Long-Term Care Medicine, 31 can help optimize antimicrobial use.…”

Section: Discussionmentioning

confidence: 99%

“…Substantial data exist to demonstrate that fluoroquinolones are frequently selected for use among nursing home residents 15,21 and older adults. 32,33 There are serious concerns about the multiple adverse events from fluoroquinolone use, 6,[33][34][35] including the emergence of antibiotic resistance and Clostridioides difficile infection and the potential for increased risk of damage to tendons, muscles, joints, the central nervous system, glucose abnormalities, and abdominal aortic aneurysm rupture.…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial Use in a Cohort of US Nursing Homes, 2017

Thompson

Stone

Brown

et al. 2021

JAMA

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IMPORTANCE Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited.OBJECTIVE To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website.EXPOSURES Residence in one of the participating nursing homes at the time of the survey. MAIN OUTCOMES AND MEASURESPrevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications. RESULTS Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI,3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics. CONCLUSIONS AND RELEVANCEIn this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents.

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Section: Limitationssupporting

confidence: 63%

Section: Nursing Homes and Residentsmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antimicrobial Use in a Cohort of US Nursing Homes, 2017

Thompson

Stone

Brown

et al. 2021

JAMA

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Bacterial and fungal load quantitative and qualitative assessment of indoor air in Portuguese long-term and acute healthcare settings

Santos-Marques

Teixeira

Pinheiro

et al. 2023

Preprint

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Background In healthcare-associated infections, the major transmission route is assumed to be the direct or indirect contact between patients, staff, and the environment. However, little is known about the air role as a pool for pathogens and multidrug resistance (MDR) in healthcare settings. The aim of this study was to quantitatively and qualitatively compare microbial air quality in a Portuguese long-term healthcare unit (LTHU) and a central hospital (CH). Methods During 2021 and 2022, air samples were collected fortnightly in both settings and their microbial load (bacteria and fungi) was determined (colony forming units – CFU/m3). Sampled sites were classified according to area, room capacity and occupation, activity and related infection potential risk. Bacterial isolates were randomly selected for identification by Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry, antimicrobial susceptibility testing and polymerase chain reaction (PCR) screening of extended-spectrum beta-lactamases and metallo-beta-lactamases genes. Results A total of 192 air samples were collected, 86 from LTHU and 106 from CH. Statistically significant differences in mean bacterial load in LTHU (367 CFU/m3) and CH (230 CFU/m3) was observed, but not in mean fungal load (LTHU: 87 CFU/m3; CH: 117 CFU/m3). CH bacteria and fungi loads were statistically significantly higher in sites with outpatients or no patients compared to those with inpatients as well as in support services compared to curative care areas. No statistically significant differences were found regarding these variables in LTHU.

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Antimicrobials in acute and long-term care: a point in time along the way to improved use

Cited by 2 publications

References 9 publications

Antimicrobial Use in a Cohort of US Nursing Homes, 2017

Antimicrobial Use in a Cohort of US Nursing Homes, 2017

Bacterial and fungal load quantitative and qualitative assessment of indoor air in Portuguese long-term and acute healthcare settings

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