Description of antibiotic use variability among US nursing homes using electronic health record data

Abstract

Background: Antibiotics are frequently prescribed in nursing homes; national data describing facility-level antibiotic use are lacking. The objective of this analysis was to describe variability in antibiotic use in nursing homes across the United States using electronic health record orders. Methods: A retrospective cohort study of antibiotic orders for 309,884 residents in 1,664 US nursing homes in 2016 were included in the analysis. Antibiotic use rates were calculated as antibiotic days of therapy (DOT) per 1,000 resident days and were compared by type of stay (short stay ≤100 days vs long stay >100 days). Prescribing indications and the duration of nursing home-initiated antibiotic orders were described. Facility-level correlations of antibiotic use, adjusting for resident health and facility characteristics, were assessed using multivariate linear regression models. Results: In 2016, 54% of residents received at least 1 systemic antibiotic. The overall rate of antibiotic use was 88 DOT per 1,000 resident days. The 3 most common antibiotic classes prescribed were fluoroquinolones (18%), cephalosporins (18%), and urinary anti-infectives (9%). Antibiotics were most frequently prescribed for urinary tract infections, and the median duration of an antibiotic course was 7 days (interquartile range, 5–10). Higher facility antibiotic use rates correlated positively with higher proportions of short-stay residents, for-profit ownership, residents with low cognitive performance, and having at least 1 resident on a ventilator. Available facility-level characteristics only predicted a small proportion of variability observed (Model R2 version 0.24 software). Conclusions: Using electronic health record orders, variability was found among US nursing-home antibiotic prescribing practices, highlighting potential opportunities for targeted improvement of prescribing practices.

National Cohort Study of Homebound Persons Living With Dementia: Antibiotic Prescribing Trends and Opportunities for Antibiotic Stewardship

“…This work suggests that the rate of antibiotic use in HBPC approaches the rate of antibiotic use in some nursing homes. A recent analysis of 1664 nursing homes found a rate of 30 DOT per 1000 resident-days among long-stay residents [ 30 ]. The current study identified a rate of 30.0 DOT per 1000 DOHC in the Midwest in 2014.…”

A Multifaceted Intervention and Its Effects on Antibiotic Usage in Norwegian Nursing Homes

“…The most common indication for antibiotic use in NHs is urinary tract infections (UTIs), including prophylaxis, usually followed by respiratory tract infections (RTIs) [ 4 , 10 , 11 , 12 , 13 , 14 ]. However, due to the high prevalence of asymptomatic bacteriuria (ABU), in combination with uncertain and challenging diagnosis in the NH population [ 15 , 16 ], many courses of antibiotics prescribed for suspected UTIs are likely unnecessary.…”

“…The most common indication for antibiotic use in NHs is urinary tract infections (UTIs), including prophylaxis, usually followed by respiratory tract infections (RTIs) [4,[10][11][12][13][14].…”