Trends in antibiotics use among long-term US nursing-home residents

Cohen, Catherine C.; Dick, Andrew W.; Agarwal, Mansi; Gračner, Tadeja; Mitchell, Susan L.

doi:10.1017/ice.2020.422

Cited by 14 publications

(15 citation statements)

References 33 publications

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“…In a previous study, antibiotic resistance rates were remarkably higher in LTCF residents than in hospitalized patients and outpatients [ 28 , 29 ]. Moreover, antibiotics are frequently prescribed in LTCFs, especially for urinary tract infections, aspiration pneumonia, and sore infections [ 30 , 31 ]. The colonization of antibiotic-resistant bacteria and frequent exposure to antibiotic agents have the potential to increase the risk of antibiotic-resistant bacterial infections.…”

Section: Discussionmentioning

confidence: 99%

Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: Microbiological distribution, antibiotic resistance, and clinical outcomes

et al. 2022

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Background Healthcare-associated pneumonia (HCAP) lies in the intersection of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). Although HCAP is excluded from the revised HAP guideline, reassessment for HCAP is needed considering its heterogeneous characteristics. Methods The microbiological distribution, antibiotic resistance, and clinical outcomes in CAP, HCAP, and HAP were studied retrospectively. The susceptibility to standard CAP regimens (β-lactams plus macrolide or fluoroquinolone monotherapy) and rates of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (P. aeruginosa) infections were evaluated in the CAP group and HCAP subgroups. Results In total, 933 cases were included (CAP, n = 557; HCAP, n = 264; HAP, n = 112). In the CAP and HCAP cases, Streptococcus pneumoniae (7.4% vs. 5.7%) and P. aeruginosa (9.2% vs. 18.6%) were the most common gram-positive and gram-negative pathogens. Staphylococcus aureus (methicillin-resistant, 2.7%; methicillin-susceptible, 2.4%) and carbapenem-resistant Acinetobacter baumannii (20.5%) were the most common Gram-positive and Gram-negative pathogens in the HAP group, respectively. Higher susceptibility to levofloxacin was observed in CAP and HCAP isolates than that to β-lactam agents. However, levofloxacin non-susceptibility was significantly higher in long-term care facility (LTCF)-onset HCAP compared to community-onset HCAP (43.6% vs. 22.7%, P = 0.014). Conclusion HCAP showed higher rates of P. aeruginosa and MRSA infections than CAP. Empirical antipseudomonal therapy should be considered in the treatment of HCAP. Prior isolation of P. aeruginosa was the most important risk factor for P. aeruginosa infection.

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Section: Discussionmentioning

confidence: 99%

Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: Microbiological distribution, antibiotic resistance, and clinical outcomes

et al. 2022

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“…It is a 4-level scale: cognitively intact (CFS = 1), mildly impaired (CFS = 2), moderately impaired (CFS = 3), and severely impaired (CFS = 4). A resident was considered to have severe cognitive impairment (ie, CFS = 4) on all assessments after these criteria were first met from the first quarterly MDS assessment . Residents with a missing CFS score were excluded from the sample (n = 1592 [0.08%]).…”

Section: Methodsmentioning

confidence: 99%

Potentially Avoidable Hospitalizations Among Historically Marginalized Nursing Home Residents

Estrada,

Barcelona,

Dhingra

et al. 2024

JAMA Netw Open

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ImportanceNursing home (NH) transfers to hospitals are common and have been associated with cognitive decline; approximately 45% of NH hospital transfers are potentially avoidable hospitalizations (PAHs).ObjectiveTo determine PAH incidence for historically marginalized NH residents with severe cognitive impairment compared with non-Hispanic White residents.Design, Setting, and ParticipantsThis cross-sectional study merged 2018 Centers for Medicaid &amp; Medicare Services datasets and LTCFocus, a public dataset on US NH care, for US NH residents aged 65 years and older who had a hospitalization. Analyses were performed from January to May 2022.ExposureRace and ethnicity of NH residents.Main Outcomes and MeasuresRacial and ethnic differences in resident-level annual rates of PAHs were estimated for residents with and without severe cognitive impairment (measured using the Cognitive Function Scale), controlling for resident characteristics, comorbidities, dual eligibility, and time at risk. PAHs were defined as NH hospital transfers that resulted from neglectful NH care or for which NH treatment would have been appropriate.ResultsOf 2 098 385 NH residents nationwide included in the study, 7151 (0.3%) were American Indian or Alaska Native, 39 873 (1.9%) were Asian, 229 112 (10.9%) were Black or African American, 99 304 (4.7%) were Hispanic, 2785 (0.1%) were Native Hawaiian or Pacific Islander, 1 713 670 (81.7%) were White, and 6490 (0.3%) were multiracial; 1 355 143 (64.6%) were female; 128 997 (6.2%) were severely cognitively impaired; and the mean (SD) age was 81.8 (8.7) years. PAH incidence rate ratios (IRRs) were significantly greater for residents with severe cognitive impairment compared with those without. In unadjusted analyses comparing historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment, American Indian or Alaska Native residents had a 49% higher PAH incidence (IRR, 1.49 [95% CI, 1.10-2.01]), Black or African American residents had a 64% higher incidence (IRR, 1.64 [95% CI, 1.48-1.81]), and Hispanic residents had a 45% higher incidence (IRR, 1.45 [95% CI, 1.29-1.62]). Higher incidences persisted for historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment in adjusted analyses. Asian residents had a 24% higher PAH incidence (IRR, 1.24 [95% CI, 1.06-1.45]), Black or African American residents had a 48% higher incidence (IRR, 1.48 [95% CI, 1.36-1.60]), and Hispanic residents had a 27% higher incidence (IRR, 1.27 [95% CI, 1.16-1.39]).Conclusions and RelevanceIn this cross-sectional study of PAHs, compared with non-Hispanic White NH residents, historically marginalized residents had increased PAH incidence. In the presence of severe cognitive impairment, incidence rates increased significantly compared with rates for residents without severe cognitive impairment. These results suggest that identification of residents with severe cognitive impairment and proper NH care may help prevent further cognitive decline by avoiding PAHs.

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“…Thus, we examined resident demographics (age, race, and gender) and clinical characteristics (behavioral problems, recent fall, depression, urinary incontinence, bowel incontinence, dementia, restraint use, pressure ulcers, anti-depressant medication, hypnotic medication, antipsychotic medication, indwelling, intermittent, and external catheters). We defined dementia using Alzheimer’s Disease and/or Related Dementias diagnoses, included as two mutually exclusive variables, both with and without Advanced Cognitive Illness (ACI), as used previously (Cohen et al, 2021). Most MDS variables used in this study had very good to excellent reliability and validity (Saliba & Buchanan, 2008).…”

Section: Methodsmentioning

confidence: 99%

The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents

et al. 2022

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Urinary tract infections (UTIs) are the most common infections among nursing home (NH) residents. Antibiotics are often misused when a UTI is suspected. Using sophisticated information technology (IT) could help in appropriate UTI prevention, diagnosis, and treatment. This repeated cross-sectional study explored relationships between IT maturity and UTI prevalence among long-stay NH residents. Data were from (1) four annual surveys 2013–2017 measuring IT maturity in a random sample of Medicare-certified NHs, (2) Minimum Data Set assessments for resident characteristics, and (3) Certification and Survey Provider Enhanced Reporting data for facility characteristics. In multivariate regressions using NH fixed effects, controlling for resident and NH characteristics, Administrative IT maturity in NHs was associated with decreased odds of UTI (AOR: 0.906, 95% CI: 0.843, 0.973). These results were robust in all sensitivity analyses. Using IT to relieve administrative burden may decrease UTIs.

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Trends in antibiotics use among long-term US nursing-home residents

Cited by 14 publications

References 33 publications

Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: Microbiological distribution, antibiotic resistance, and clinical outcomes

Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: Microbiological distribution, antibiotic resistance, and clinical outcomes

Potentially Avoidable Hospitalizations Among Historically Marginalized Nursing Home Residents

The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents

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