Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T12:38:16.521Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  16 September 2020

Catherine C. Cohen ,
Andrew W. Dick ,
Mansi Agarwal Open the ORCID record for Mansi Agarwal [Opens in a new window] ,
Tadeja Gracner ,
Susan Mitchell  and
Patricia W. Stone
Catherine C. Cohen*
Affiliation:
Behavioral & Policy Sciences, RAND Corporation, Santa Monica, California
Andrew W. Dick
Affiliation:
Economics, Sociology & Statistics, RAND Corporation, Boston, Massachusetts
Mansi Agarwal*
Affiliation:
Center for Health Policy, Columbia University School of Nursing, New York, New York
Tadeja Gracner
Affiliation:
Economics, Sociology & Statistics, RAND Corporation, Washington, DC
Susan Mitchell
Affiliation:
Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts
Patricia W. Stone
Affiliation:
Center for Health Policy, Columbia University School of Nursing, New York, New York
*
Authors for correspondence: Catherine C. Cohen, E-mail: [email protected]. Or Mansi Agarwal, E-mail: [email protected].
Authors for correspondence: Catherine C. Cohen, E-mail: [email protected]. Or Mansi Agarwal, E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Antibiotics are overly prescribed in nursing homes. Recent antibiotic stewardship efforts attempt to reduce inappropriate use. Our objective was to describe antibiotic use from 2012 to 2016 among nursing-home residents with various health conditions.

Design:

Retrospective, repeated cross-sectional analysis.

Setting and participants:

All long-term residents in a random 10% sample of national nursing homes: 2,092,809 assessments from 319,615 nursing-home residents in 1,562 nursing homes.

Measurements:

We calculated a 1-day antibiotic prevalence using all annual and quarterly clinical assessments in the Minimum Data Set (MDS) from April 2012 through December 2016. We calculated prevalence of antibiotic use overall and within conditions of interest: Alzheimer’s disease and related dementias (ADRD), advanced cognitive impairment (ACI), and infections likely to be treated with antibiotics. We applied logistic regressions with nursing-home cluster, robust standard errors to assess changes in conditions and antibiotic use 2012–2016.

Results:

Overall, antibiotic use did not change (2012 vs 2016, adjusted odds ratio [AOR], 1.00; 95% CI, 0.97–1.03). Antibiotic use was higher in 2016 versus 2012 among assessments with any infection (AOR, 1.10; 95% CI, 1.04–1.16), urinary tract infection (AOR, 1.18; 95% CI, 1.12–1.25), and no infection (AOR, 1.13; 95% CI, 1.09–1.17). Results were similar by cognitive status.

Conclusions:

The increased proportion of assessments recording antibiotics but no infection may not be clinically appropriate. Higher antibiotic use among infected residents with advanced cognitive impairment is also concerning. Further efforts to understand mechanisms driving these trends and to promote antibiotic stewardship in nursing homes are warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 3 , March 2021 , pp. 311 - 317
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Harris-Kojetin, L, Sengupta, M, Lendon, J, Rome, V, Valverde, R, Caffrey, C. Long-term Care Providers and Services Users in the United States, 2015–2016. Washington, DC: National Center for Health Statistics; 2019: 43.Google Scholar
Nursing homes and assisted living (long-term care facilities [LTCFs]). Centers for Disease Control and Prevention website. https://www.cdc.gov/longtermcare/index.html. Published 2019. Accessed January 13, 2020.Google Scholar
Faulkner, CM, Cox, HL, Williamson, JC. Unique aspects of antimicrobial use in older adults. Clin Infect Dis 2005;40:997–1004.CrossRefGoogle ScholarPubMed
Kyne, L, Merry, C, O’Connell, B, Kelly, A, Keane, C, O’Neill, D. Factors associated with prolonged symptoms and severe disease due to Clostridium difficile . Age Ageing 1999;28:107–113.CrossRefGoogle ScholarPubMed
Herzig, CT, Dick, AW, Sorbero, M, et al. Infection trends in US nursing homes, 2006–2013. J Am Med Director Assoc 2017;18:635.e639–635.e620.CrossRefGoogle Scholar
Rogers, MA, Mody, L, Chenoweth, C, Kaufman, SR, Saint, SJ. Incidence of antibiotic-resistant infection in long-term residents of skilled nursing facilities. Am J Infect Control 2008;36:472–475.CrossRefGoogle ScholarPubMed
Bernatz, JT, Safdar, N, Hetzel, S, Anderson, PA. Antibiotic overuse is a major risk factor for Clostridium difficile infection in surgical patients. Infect Control Hosp Epidemiol 2017;38:1254–1257.CrossRefGoogle ScholarPubMed
Evans, CT, Safdar, N. Current trends in the epidemiology and outcomes of Clostridium difficile infection. Clin Infect Dis 2015;60 suppl 2:S66–S71.CrossRefGoogle Scholar
Centers for Disease Control & Prevention. Antibiotic Resistant Threats in the United States. Atlanta, GA: U.S. Department of Health and Human Services; 2019.Google Scholar
Freedberg, DE, Salmasian, H, Cohen, B, Abrams, JA, Larson, EL. Receipt of antibiotics in hospitalized patients and risk for Clostridium difficile infection in subsequent patients who occupy the same bed. JAMA Intern Med 2016;176:1801–1808.CrossRefGoogle ScholarPubMed
Shorr, AF, Zilberberg, MD, Wang, L, Baser, O, Yu, H. Mortality and costs in Clostridium difficile infection among the elderly in the United States. Infect Control Hosp Epidemiol 2016;37:1331–1336.CrossRefGoogle ScholarPubMed
D’Agata, E, Mitchell, SL. Patterns of antimicrobial use among nursing home residents with advanced dementia. J Arch Intern Med 2008;168:357–362.CrossRefGoogle ScholarPubMed
Ford, PJ, Fraser, TG, Davis, MP, Kodish, E. Anti-infective therapy at the end of life: ethical decision-making in hospice-eligible patients. Bioethics 2005;19:379–392.CrossRefGoogle ScholarPubMed
Seitz, D, Purandare, N, Conn, D. Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. Int Psychogeriatr 2010;22:1025–1039.CrossRefGoogle ScholarPubMed
American Medical Directors Association. Common infections in the long-term care setting clinical practice guideline. Columbia, MD: AMDA; 2011: 1–46.Google Scholar
El Chakhtoura, NG, Bonomo, RA, Jump, RLP. Influence of aging and environment on presentation of infection in older adults. Infect Dis Clin N Am 2017;31:593–608.CrossRefGoogle ScholarPubMed
Mitchell, SL, Teno, JM, Kiely, DK, et al. The clinical course of advanced dementia. N Engl J Med 2009;361:1529–1538.CrossRefGoogle ScholarPubMed
Gavazzi, G, Krause, KH. Ageing and infection. Lancet Infect Dis 2002;2:659–666.CrossRefGoogle ScholarPubMed
Beckett, CL, Harbarth, S, Huttner, B. Special considerations of antibiotic prescription in the geriatric population. Clin Microbiol Infect 2015;21:3–9.CrossRefGoogle ScholarPubMed
Parsons, C, van der Steen, JT. Antimicrobial use in patients with dementia: current concerns and future recommendations. CNS Drugs 2017;31:433–438.CrossRefGoogle ScholarPubMed
van der Steen, JT, Di Giulio, P, Giunco, F, et al. Pneumonia in nursing home patients with advanced dementia: decisions, intravenous rehydration therapy, and discomfort. Am J Hosp Palliat Care 2018;35:423–430.CrossRefGoogle ScholarPubMed
Parsons, C. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Ther Adv Drug Saf 2017;8:31–46.CrossRefGoogle ScholarPubMed
Mitchell, SL, Shaffer, ML, Loeb, MB, et al. Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia. JAMA Intern Med 2014;174:1660–1667.CrossRefGoogle ScholarPubMed
Sloane, PD, Zimmerman, S, Reed, D, et al. Antibiotic prescribing in 4 assisted-living communities: incidence and potential for improvement. Infect Control Hosp Epidemiol 2014;35 suppl 3:S62–S68.CrossRefGoogle Scholar
Albrecht, JS, McGregor, JC, Fromme, EK, Bearden, DT, Furuno, JP. A nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain Symptom Manag 2013;46:483–490.CrossRefGoogle ScholarPubMed
Nicolle, LE, Bentley, DW, Garibaldi, R, Neuhaus, EG, Smith, PW. Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee. Infect Control Hosp Epidemiol 2000;21:537–545.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. The core elements of antibiotic stewardship for nursing homes. Atlanta, GA: CDC; 2015.Google Scholar
Society for Healthcare Epidemiology of America. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). J Infect Control Hosp Epidemiol 2012;33:322–327.CrossRefGoogle Scholar
The White House national action plan for combating antibiotic-resistant bacteria. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/pdf/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published 2015. Accessed March 13, 2020.Google Scholar
Centers for Medicare & Medicaid Services. Reform of Requirements for Long-Term Care Facilities. Final rule, vol 81. Washington, DC: US Department of Health and Human Services; 2016: 68688–68872.Google Scholar
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62(10):e51-e77.CrossRefGoogle Scholar
MDS 3.0 for nursing homes and swing bed providers. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/nursing homeQIMDS30.html. Accessed March 13, 2020.Google Scholar
Centers for Medicare & Medicaid Services. Long-Term Care Facility Resident Assessment Instrument User’s Manual Version 3.0. In. Washington DC Department of Health & Human Services; 2013.Google Scholar
Saliba, D, Buchanan, J. Development and Validation of a Revised Nursing Home Assessment Tool: MDS 3.0. RAND Corporation; April 2008.Google Scholar
Liu, H, Herzig, CTA, Dick, AW, et al. Impact of state reporting laws on central line-associated bloodstream infection rates in US adult intensive care units. Health Serv Res 2017;52:1079–1098.CrossRefGoogle Scholar
Thomas, KS, Dosa, D, Wysocki, A, Mor, V. The minimum data set 3.0 cognitive function scale. J Med Care 2017;55(9):e68.CrossRefGoogle ScholarPubMed
Mitchell, SL, Miller, SC, Teno, JM, Davis, RB, Shaffer, ML. The advanced dementia prognostic tool: a risk score to estimate survival in nursing home residents with advanced dementia. J Pain Symptom Manag 2010;40:639–651.CrossRefGoogle ScholarPubMed
Stata Statistical Software: Release 15 [computer program]. College Station, TX; 2017.Google Scholar
Kabbani, S, Palms, D, Bartoces, M, Stone, N, Hicks, LA. Outpatient antibiotic prescribing for older adults in the United States: 2011 to 2014. J Am Geriatr Soc 2018;66:1998–2002.CrossRefGoogle ScholarPubMed
Daneman, N, Gruneir, A, Newman, A, et al. Antibiotic use in long-term care facilities. J Antimicrob Chemother 2011;66:2856–2863.CrossRefGoogle ScholarPubMed
Pakyz, AL, Dwyer, LL. Prevalence of antimicrobial use among United States nursing home residents: results from a national survey. Infect Control Hosp Epidemiol 2010;31:661–662.CrossRefGoogle ScholarPubMed
Warren, JW, Palumbo, FB, Fitterman, L, Speedie, SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39:963–972.CrossRefGoogle ScholarPubMed
Alexander, GL, Madsen, R, Deroche, CB, Alexander, R, Miller, E. Ternary trends in nursing home information technology and quality measures in the United States. J Appl Gerontol 2019. doi: 10.1177/0733464819862928.Google ScholarPubMed
Payer denials hit sepsis amid conflicting clinical protocols; diagnosis is doubted. Health Care Compliance Association website. https://assets.hcca-info.org/Portals/0/PDFs/Resources/Rpt_Medicare/2017/rmc052217.pdf?ver=2017-05-19-103818-393. Published 2017. Accessed August 31, 2020.Google Scholar
Barbash, IJ, Kahn, JM, Thompson, BT. Opening the debate on the new sepsis definition. Medicare’s sepsis reporting program: two steps forward, one step back. Am J Respir Crit Care Med 2016;194:139–141.CrossRefGoogle ScholarPubMed
Pinson, RD. Sepsis-3: the world turned upside down. ACP Hospitalist website. https://acphospitalist.org/archives/2016/03/coding-sepsis-confusing-part-2.htm. Published March 2016. Accessed July 9 2020.Google Scholar
Frieden, J. CMS sepsis measures spark controversy. Medpage Today website. https://www.medpagetoday.com/publichealthpolicy/medicare/53146. Published 2015. Updated August 19, 2015. Accessed March 13, 2020.Google Scholar
Supplementary material: File

Cohen et al. supplementary material

Appendix C

Download Cohen et al. supplementary material(File)
File 21.4 KB
Supplementary material: File

Cohen et al. supplementary material

Appendix A and B

Download Cohen et al. supplementary material(File)
File 317.5 KB