Epidemiology of Antibiotic Use for Urinary Tract Infection in Nursing Home Residents

Thompson, Nicola D.; Penna, Austin; Eure, Taniece; Bamberg, Wendy; Barney, Grant; Barter, Devra; Clogher, Paula; DeSilva, Malini B.; Dumyati, Ghinwa; Epson, Erin; Frank, Linda; Godine, Deborah; Irizarry, Lourdes; Kainer, Marion A.; Li, Linda; Lynfield, Ruth; Mahoehney, J.P.; Nadle, Joelle; Ocampo, Valerie; Perry, L; Ray, Susan M.; Davis, Sarah Shrum; Sievers, Marla; Wilson, Lucy; Zhang, Alexia Y.; Stone, Nimalie D.; Magill, Shelley S.

doi:10.1016/j.jamda.2019.11.009

Cited by 22 publications

(24 citation statements)

References 17 publications

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“…1 Notably, approximately half of E. coli isolates from nursing homes were fluroquinolone resistant in both SUTI and CA-SUTI events. Recent publications have reported that fluoroquinolones are the most commonly used antibiotic for UTIs among US nursing home residents and elderly outpatients [20][21][22] and have been associated with severe adverse events in the elderly. 20 The high rate of fluoroquinolone resistance highlights a need for public health officials, infection preventionists, and clinical providers to further reinforce antibiotic stewardship activities aimed at curbing the inappropriate use of fluoroquinolones for UTIs in nursing homes.…”

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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“…Of those transfers, 75% could have been avoided because appropriate treatment was available in the nursing home or because transfer to hospital was inconsistent with resident and family preferences (Givens et al 2012;Mitchell 2015). Common (but usually inappropriate) care at end of life in nursing homes includes administering antipsychotic medication without a diagnosis of psychosis (Schneider et al 2006;Banerjee 2009;Declercq et al 2013;Juola et al 2016;Gurwitz et al 2017), inappropriate medication management for depression (Burns and Winblad 2006;Choi et al 2008), use of physical restraints (Engberg et al 2008;Castle and Engberg 2009;Köpke et al 2012;Foebel et al 2016;Abraham et al 2019), multiple simultaneous medications prescribed (Tamura et al 2012;Jokanovic et al 2015;Kröger et al 2015;Martín-Pérez et al 2019), indwelling urinary catheters (Flaherty 2004;Getliffe 2008;Gurwitz et al 2016), and aggressive treatments such as renal dialysis (Muthalagappan et al 2013;Tamura et al 2017) or non-pain-related intravenous therapy such as antibiotics (Mitchell et al 2004;Volicer 2004;Thompson et al 2020).…”

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confidence: 99%

Restoring trust: COVID-19 and the future of long-term care in Canada

Estabrooks

Straus

Flood

et al. 2020

FACETS

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The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.

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“…In both small and large-scale studies of U.S. nursing homes, fluoroquinolones are often the most commonly prescribed agents 20,22,[28][29][30] ; this holds true for nursing homes in some regions outside of the United States. 21,31,32 One potential reason for the relatively abundant use of fluoroquinolones may include prescribers' practice patterns.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes

Song

Wilson

Bej

et al. 2020

J American Geriatrics Society

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BACKGROUND Data describing antibiotic use in U.S. nursing homes remain limited. We report antibiotic use among skilled nursing facility residents from 29 U.S. nursing homes and assessed correlations between antibiotics prescribed to residents in skilled care and nursing home characteristics. DESIGN Retrospective cohort study. SETTING Twenty‐nine U.S. nursing homes in the same healthcare corporation. PARTICIPANTS Residents receiving skilled care in 2016. MEASUREMENTS We used pharmacy invoice and nursing home census data to calculate the days of antibiotic therapy per 1,000 days of skilled care (1,000 DOSC), the rate of antibiotic starts per 1,000 DOSC, the length of antibiotic therapy, and the average antibiotic spectrum index. We also assessed correlations between antibiotic use and nursing home characteristics. RESULTS Antibiotics accounted for an average of 9.6% (±0.6%) of systemic medications prescribed among residents receiving skilled care. On average, 26.8% (±2.9%) of antibiotics were intravenous. Fluoroquinolones were prescribed at the highest rates (19% across all facilities), followed by beta‐lactam/beta‐lactamase inhibitors (11%), first‐ and second‐generation cephalosporins, sulfonamides, and oral tetracyclines (each at 9%). Both the proportion of residents using enrolled in Medicare and number of unique prescribers responsible for systemic prescriptions positively correlated with the rate of antibiotic starts. CONCLUSIONS Our study demonstrates that pharmacy invoices represent a useful and preexisting source of data for assessing antibiotic prescriptions among individuals receiving skilled nursing care. The correlation between the number of unique prescribers and antibiotic starts suggests that prescribers are central to efforts to improve antibiotic use in nursing homes.

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Epidemiology of Antibiotic Use for Urinary Tract Infection in Nursing Home Residents

Cited by 22 publications

References 17 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

Restoring trust: COVID-19 and the future of long-term care in Canada

Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes

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