Appropriateness of antibiotic therapy in long-term care facilities

Indicators of Potentially Drug-Resistant Bacteria in Severe Nursing Home--Acquired Pneumonia

“…The current predictive model depicted previous use of antimicrobial agents and functional status as indicators for DRPrelated pneumonia in institutionalized elderly patients. The use of antimicrobial agents has been identified as an important factor in the emergence of antibiotic-resistant gram-positive and gram-negative bacterial infections in long-term care facilities [20,21]. It is thought that receipt of antibiotics alters the normal flora in the upper respiratory tract, allowing resistant nosocomial bacteria to colonize patients [22] and subsequently causing DRP-associated pneumonia.…”

Antibiotic Resistance in Nursing Homes

“…Previous study have found relatively high rates of antimicrobial use and substantial inappropriate use of antimicrobial agents in nursing homes and longterm care facilities (Zimmer JG & Al, 1986;Crossley K & Al 1987;Jones SR & Al, 1987;Katz PR & Al, 1990;Yakabowich MR & Al, 1994;Pickering TD & Al, 1994;Montgomery P & Al, 1995). In addition to increasing the risk of colonization or infection with antimicrobial-resistant organisms, inappropriate antimicrobial use adds cost to resident care and may place the patient at increased risk for drug adverse reactions (Mylotte JM, 1999).…”

“…A substantial proportion of antimicrobial treatment in nursing homes is considered inappropriate: from 30 to 75% of systemic antimicrobial agents (Zimmer JG & Al, 1986;Crossley K & Al 1987;Jones SR & Al, 1987;Katz PR & Al, 1990;Yakabowich MR & Al, 1994;Pickering TD & Al, 1994;Montgomery P & Al, 1995) and up to 60% of topical antimicrobial agents (Montgomery P & Al, 1995) are inappropriately used.…”

Approach to the problem of pneumonia in long-term care facilities

“…Antibiotic therapy prescribed to nursing home patients is often inappropriate or unjustified. [54][55][56] Patients who do not receive initial evaluation by a physician or nurse practitioner during an episode of pneumonia appear to be more likely to die or to require transfer to a hospital. 57 Nursing home patients are frequently transported to hospital emergency departments for therapy that could be administered in the nursing home.…”