Effective Antimicrobial Stewardship in a Long-Term Care Facility through an Infectious Disease Consultation Service: Keeping a LID on Antibiotic Use

Abstract

Design We introduced a long-term care facility (LTCF) Infectious Disease (ID) consult service (LID) that provides on-site consultations to residents of a VA LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF. Setting A 160-bed Veterans Affairs (VA) LTCF. Methods Systemic antimicrobial use and the rate of positive C. difficile tests at the LTCF were compared for 36 months before and 18 months after the initiation of the ID consultation service using segmented regression analysis of an interrupted time-series. Results In contrast to the pre-intervention period, total systemic antibiotic administration decreased by 30% (P <.001) with a significant reduction in both oral (32%; P<.001) and intravenous agents (25%; P =.008). The greatest reductions were seen for tetracyclines (64%, P <.001), clindamycin (61%; P <.001), sulfamethoxazole/trimethoprim (38%; P <.001), fluoroquinolones (38%; P <.001) and beta-lactam/beta-lactamase inhibitor combinations (28%; P <.001). Rates of change for positive C. difficile tests at the LTCF declined in the post- vs. preintervention periods (P = .04). Conclusions Implementation of a LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with infectious disease expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.

Impact of Antimicrobial Stewardship on Physician Practice in a Geriatric Facility

“…[14][15][16] The current study had similar overall results but suggests the existence of significant barriers to change. For example, the ASP at the study institution involved a small team, functioned at the program level rather than as part of the clinical team, used an external pharmacy for prescriptions generated in the LTC facility (which resulted in a lack of control over the formulary), and did not have on-site infectious disease services.…”

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

“…Similarly, at SHSC-VC, antibiotic therapy was prolonged (longer than 7 days) for 36% of prescriptions. Daneman and others 11 and Jump and others 12 showed that the most common antibiotics (nitrofurantoin, trimethoprimsulfamethoxazole, and ciprofloxacin) used for long-term care residents were indicated for suspected urinary tract infections. In the current study, urine was the most common culture source and ciprofloxacin the most commonly used antibiotic, results that concur with previous studies.…”

“…In the current study, urine was the most common culture source and ciprofloxacin the most commonly used antibiotic, results that concur with previous studies. 11,12 A prospective study evaluating the indications for use of antibiotics in one or more long-term care facilities would be of value to definitively determine whether fluoroquinolones are most commonly used to treat suspected urinary tract infections in this patient population.…”

“…The primary outcome of interest was median days of therapy (DOT) per 1000 patient-days per month 12 from April 1, 2011, to March 31, 2012. Any dose of an antibiotic received during a 24-h period represented 1 DOT.…”

“…11,12 Therefore, identification of unique antimicrobial stewardship strategies to optimize antibiotic use in such facilities is greatly needed.…”