Opportunities to Improve Antimicrobial Use in US Nursing Homes

Crnich, Christopher; Malani, Preeti N.

doi:10.1001/jama.2021.3258

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…Thus, nursing homes should embrace efforts to implement decision support into clinical practice and systemwide efforts to control the use of unnecessary testing such as urinalysis and urine cultures. 3 With increasing electronic health records in nursing homes, now is the time to advance clinical decision support. 14 Current interventions to improve the appropriateness of antibiotic prescribing for UTIs fail to sufficiently control for these issues and may explain their lack of success in long-term care.…”

Section: Discussionmentioning

confidence: 99%

“…2 Which categories of patient-level information drive UTI overdiagnosis remains unclear because most research in this field has been observational. 3 In this study, we address the question: “How likely is it that the patient has a UTI?” using the choices “likely,” “uncertain,” and “unlikely.” 4 Specifically, using a novel experimental design, we sought to determine which patient-level information was most associated with a “false positive” diagnosis or “overdiagnosis” of a suspected UTI.…”

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confidence: 99%

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Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: A discrete choice experiment

Wretman¹,

Boynton

Preisser

et al. 2022

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: A discrete choice experiment

Wretman¹,

Boynton

Preisser

et al. 2022

Infect. Control Hosp. Epidemiol.

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“…► Leveraging antibiotic stewardship expertise in acute care hospitals that LTCHs already have a relationship with to address stewardship across the care continuum. 20 ► Collaboration with LTCH and their contracted laboratory to develop facility-specific antibiograms. 12 on June 6, 2021 by guest.…”

Section: Interorganisational Networkmentioning

confidence: 99%

Support to scale antibiotic stewardship in long-term care homes: how much is enough?

Szymczak

Trautner

2021

BMJ Qual Saf

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“…Additionally, patients often seek care at different hospitals and health systems, so key aspects of their microbiologic and antibiotic use histories may not be available. In the future, regional approaches with central repositories of history of multidrug-resistant organisms could help inform empiric antibiotic prescribing . The use of artificial intelligence may accelerate the ability for EHR vendors to develop more robust models to predict the risk of multidrug-resistant organisms associated with suspected infection.…”

mentioning

confidence: 99%

Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing

Malani,

Malani

2024

JAMA

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Approximately half of hospitalized adults in the US receive antibiotics, with pneumonia and urinary tract infection (UTI) being the 2 most frequent indications. 1 Estimates suggest about 30% of all antibiotics prescribed in US hospitals are either unnecessary or suboptimal, 2 and extended-spectrum antibiotic use is common. 3 Unnecessary antibiotic use contributes to numerous harms, including drug-related adverse effects, increased risk of drug resistance, and higher costs.Antimicrobial stewardship aims to optimize antimicrobial use, minimize associated harms, and improve clinical outcomes, and over the past 2 decades, the field of stewardship has emerged and evolved. In 2014, the US Centers for Disease Control and Prevention introduced the Core Elements of Hospital Antibiotic Stewardship Programs to help hospitals with implementation. 2 Among these Core Elements are hospital leadership commitment, accountability, pharmacy expertise, action, tracking, reporting, and education.In 2015, the US National Action Plan for Combating Antibiotic-Resistant Bacteria set an implementation goal of the Centers for Disease Control and Prevention's Core Elements in all hospitals that receive federal funding. By 2022, an impressive 97% of approximately 5100 US acute care hospitals reported meeting all 7 Core Elements of effective antimicrobial stewardship programs compared with only 41% in 2014. 4 With much of the low-hanging fruit of stewardship interventions already picked (eg, guideline development and formulary restrictions), the demand for novel, scalable, sustainable strategies remains, especially addressing the empiric use of extended-spectrum antibiotic therapy.In this issue of JAMA, Gohil and colleagues report the results of 2 related trials examining the use of computerized provider order entry (CPOE) prompts to reduce empiric use of extended-spectrum antibiotics among adults admitted for either pneumonia or UTI. 5,6 The INSPIRE Pneumonia and INSPIRE UTI trials were conducted at a network of 59 geographically diverse community hospitals across the US. Using a cluster-randomized design, the investigators compared routine stewardship (ie, education, feedback) with the CPOE bundle composed of routine stewardship plus CPOE entry prompts that recommended standard-spectrum instead of extended-spectrum antibiotics during the first 3 hospital days (empiric period) for patients with a low absolute risk (<10%) of infections associated with multidrug-resistant organisms.

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Opportunities to Improve Antimicrobial Use in US Nursing Homes

Cited by 5 publications

References 12 publications

Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: A discrete choice experiment

Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: A discrete choice experiment

Support to scale antibiotic stewardship in long-term care homes: how much is enough?

Harnessing the Electronic Health Record to Improve Empiric Antibiotic Prescribing

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