Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homes

Thompson, Nicola D.; LaPlace, Lisa; Epstein, Lauren; Thompson, Deborah; Dumyati, Ghinwa; Concannon, Cathleen; Quinlan, Gail; Witten, Tory; Warnke, Linn; Lynfield, Ruth; Maloney, Meghan; Melchreit, Richard; Stone, Nimalie D.

doi:10.1016/j.jamda.2016.08.013

Cited by 29 publications

(24 citation statements)

References 6 publications

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“…Nursing homes or long term care facilities in the United States and Australia were found to be a reservoir for AMR pathogens due to excessive, inappropriate and prolonged broad-spectrum antimicrobial use, inadequate infection control and increased risk of pathogen colonization [12,13]. The prevalence of antimicrobial consumption in nursing homes was reported to be 11% in the United States, where only 66% of it was documented for therapeutic use [14].…”

Section: Introductionmentioning

confidence: 99%

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

et al. 2019

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Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults' knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.

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Section: Introductionmentioning

confidence: 99%

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

et al. 2019

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“…13 A recent 1-day point prevalence survey of 9 NHs in 4 states found antibiotics used in 11% of residents and that key prescribing information was not documented for 38% of antibiotics prescribed. 14 For these reasons, improving infection prevention and control and management, including antibiotic stewardship, in NHs have become national priorities. In 2016, the CMS final rule required that NHs develop an infection control program that includes antibiotic stewardship and employ a trained infection preventionist (IP) whose main responsibility is the infection control program.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study

Stone

Herzig

Agarwal

et al. 2018

INQUIRY

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Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly (P < .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P < .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs.

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“…1 Of the 1.4 million individuals who reside in a nursing home on daily basis, 2 8%-11% are actively being treated with an antibiotic. 3,4 More than half of the residents who reside in a nursing home for ≥6 months are prescribed 1 or more antibiotic courses, with a mean of 4.6-4.8 courses per 1,000 resident days. 1,5 Antibiotic therapy is associated with a number of potential harms, including adverse drug reactions and Clostridioides difficile infection (CDI) as well as increased resident risk of colonization with and spread of multidrug-resistant bacteria.…”

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confidence: 99%

Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes

Liao

Nace

Crnich

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background:Antibiotic overuse and misuse is a common problem in nursing homes. Antibiotic time-out (ATO) interventions have led to improvements in antibiotic uses in hospitals, but their impact in nursing homes remain understudied.Objective:To evaluate the impact of a stewardship intervention, promoting use of ATOs on the frequency and types of antibiotic change events (ACEs) in nursing homes.Design:Controlled before-and-after intervention study.Setting:Nursing homes in Wisconsin and Pennsylvania.Method:Data on antibiotic prescriptions in 11 nursing homes were collected for 25 months. We categorized ACEs as (1) early discontinuation, (2) class modification, or (3) administration modification. Class modification ACEs were further classified based on whether the change narrowed, expanded, or had no effect on bacterial spectrum coverage. Analyses were performed using a difference-in-difference (DiD) approach.Result:Of 2,647 antibiotic events initiated in study nursing homes, 376 (14.2%) were associated with an ACE. The overall proportion of ACEs did not significantly differ between intervention and control nursing homes. Early discontinuation ACEs increased in intervention nursing homes (DiD, 2.5%; P = .01), primarily affecting residents initiated on broad-spectrum antibiotics (DiD, 2.9%; P < .01). Class modification ACEs decreased in intervention nursing homes but remained unchanged in control nursing homes.Conclusion:The impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. More research on the potential value of ATO interventions in nursing homes is warranted.

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Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homes

Abstract: Opportunities to improve AU documentation and prescribing exist in nursing homes.

Cited by 29 publications

References 6 publications

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study

Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes

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