Are Antibiograms Ready for Prime Time in the Nursing Home?

Nace, David A.; Fridkin, Scott K.

doi:10.1016/j.jamda.2019.11.021

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Individual nursing homes may be unable to generate sufficient susceptibility data within a year to create reliable, facility-specific antibiograms. 16,24 Therefore, pooling of susceptibility data from nursing homes within a geographic region or nationally to track and identify important changes in antibiotic resistance in nursing homes will be necessary.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Eure

Stone

Mungai

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: Antibiotic resistance (AR) is a growing and highly prevalent problem in nursing homes. We describe selected AR phenotypes from pathogens causing urinary tract infections (UTIs) reported by nursing homes to the National Healthcare Safety Network (NHSN). Design: Pathogens and antibiotic susceptibility testing results for UTI events in nursing homes between January 2013 and December 2017 were analyzed. The pathogen distribution and pooled mean proportion of isolates that tested resistant to select antibiotic agents are reported. Setting and Participants: US nursing homes voluntarily participating in the Long-Term Care Facility component of the NHSN. Results: Overall, 243 nursing homes reported 1 or more UTIs: 121 (50%) were nonprofit facilities, median bed size was 91 (range: 9–801), and average occupancy was 87%. In total, 6,157 pathogens were reported for 5,485 UTI events. Moreover, 9 pathogens accounted for 90% of all reported UTIs; the 3 most frequently identified were Escherichia coli (41%), Proteus species (14%), and Klebsiella pneumoniae/oxytoca (13%). Among E. coli, fluoroquinolone, and extended-spectrum cephalosporin resistance were most prevalent (50% and 20%, respectively). Although Staphylococcus aureus and Enterococcus faecium represented <5% of pathogens reported, they had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Multidrug resistance was most common in Pseudomonas aeruginosa (11%). For the resistant phenotypes we assessed, 36% of all UTIs reported were associated with a resistant pathogen. Conclusions: This is the first summary of AR among common pathogens causing UTIs reported to NHSN by nursing homes. Improved understanding of the resistance burden among common infections helps inform facility infection prevention and antibiotic stewardship efforts.

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Section: Discussionmentioning

confidence: 99%

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Eure

Stone

Mungai

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…37 Therefore, appropriate use of microbial cultures is important in optimizing antibiotic use and often involves policy and practice changes such as removing policies that promote automatic culturing, introducing diagnostic algorithms, and creating alternative order sets promoting close monitoring over antibiotic prescribing when cultures are positive but patients are not ill. 38 This issue of JAMDA contains 2 articles that add to this knowledge baseda study documenting that hospital and nursing home cultures may differ markedly within the same geographic region 39 and a report indicating that microbial culture rates in US Veterans Affairs nursing homes have declined, likely in response to initiatives aimed at decreasing unnecessary cultures 15 dplus an editorial that provides guidance for nursing homes on best practices regarding antibiograms. 40…”

Section: Role Of Cultures and Antibiogramsmentioning

confidence: 99%

Progress and Challenges in the Management of Nursing Home Infections

Sloane

Zimmerman

Nace

2020

Journal of the American Medical Directors Association

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“…Harms of exposure to multiple antibiotic classes or overly broad therapy include increased risk of developing C difficile diarrhea and future infection by antibiotic-resistant bacteria, as well as spread of resistant bacteria to other NH residents . In NHs, over 90% of performed cultures are from urine samples, and urinary tract infections (UTIs) are the most common indication for antibiotic initiation . Improving the quality of empirical antibiotic decisions is a critical step toward improving antibiotic safety and effectiveness in NHs.…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 In NHs, over 90% of performed cultures are from urine samples, and urinary tract infections (UTIs) are the most common indication for antibiotic initiation. 12 , 13 , 14 Improving the quality of empirical antibiotic decisions is a critical step toward improving antibiotic safety and effectiveness in NHs.…”

Section: Introductionmentioning

confidence: 99%

Syndromic Antibiograms and Nursing Home Clinicians’ Antibiotic Choices for Urinary Tract Infections

Taylor,

Wilson,

Singh

et al. 2023

JAMA Netw Open

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ImportanceEmpirical antibiotic prescribing in nursing homes (NHs) is often suboptimal. The potential for antibiograms to improve empirical antibiotic decision-making in NHs remains poorly understood.ObjectiveTo determine whether providing NH clinicians with a urinary antibiogram improves empirical antibiotic treatment of urinary tract infections (UTIs).Design, Setting, and ParticipantsThis was a survey study using clinical vignettes. Participants were recruited via convenience sampling of professional organization listservs of NH clinicians practicing in the US from December 2021 through April 2022. Data were analyzed from July 2022 to June 2023.InterventionsRespondents were randomized to complete vignettes using a traditional antibiogram (TA), a weighted-incidence syndromic combination antibiogram (WISCA), or no tool. Participants randomized to antibiogram groups were asked to use the antibiogram to empirically prescribe an antibiotic. Participants randomized to the no tool group functioned as controls.Main Outcomes and MeasuresEmpirical antibiotic selections were characterized as microbiologically (1) active and (2) optimal according to route of administration and spectrum of activity.ResultsOf 317 responses, 298 (95%) were included in the analysis. Duplicate responses (15 participants), location outside the US (2 participants), and uninterpretable responses (2 participants) were excluded. Most respondents were physicians (217 respondents [73%]) and had over 10 years of NH practice experience (155 respondents [52%]). A mixed-effects logistic model found that use of the TA (odds ratio [OR], 1.41; 95% CI, 1.19-1.68; P &lt; .001) and WISCA (OR, 1.54; 95% CI, 1.30-1.84; P &lt; .001) were statistically superior to no tool when choosing an active empirical antibiotic. A similarly constructed model found that use of the TA (OR, 1.94; 95% CI, 1.42-2.66; P &lt; .001) and WISCA (OR, 1.7; 95% CI, 1.24-2.33; P = .003) were statistically superior to no tool when selecting an optimal empirical antibiotic. Although there were differences between tools within specific vignettes, when compared across all vignettes, the TA and WISCA performed similarly for active (OR, 1.09; 95% CI, 0.92-1.30; P = .59) and optimal (OR, 0.87; 95% CI, 0.64-1.20; P = .69) antibiotics.Conclusions and RelevanceProviding NH clinicians with a urinary antibiogram was associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions. Although the antibiogram format was not associated with decision-making in aggregate, context-specific effects may have been present, supporting further study of syndromic antibiograms in clinical practice.

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Are Antibiograms Ready for Prime Time in the Nursing Home?

Cited by 6 publications

References 22 publications

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Progress and Challenges in the Management of Nursing Home Infections

Syndromic Antibiograms and Nursing Home Clinicians’ Antibiotic Choices for Urinary Tract Infections

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