Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T04:30:32.807Z Has data issue: false hasContentIssue false
  • English
  • Français

Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities

Published online by Cambridge University Press:  10 May 2016

Jon P. Furuno ,
Angela C. Comer ,
J. Kristie Johnson ,
Joseph H. Rosenberg ,
Susan L. Moore ,
Thomas D. MacKenzie ,
Kendall K. Hall  and
Jon Mark Hirshon
Jon P. Furuno
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon
Angela C. Comer
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland National Study Center for Trauma and EMS, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Joseph H. Rosenberg
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Susan L. Moore
Affiliation:
Department of Patient Safety and Quality, Denver Health and Hospital Authority, Denver, Colorado; and Department of Medicine, University of Colorado Health Sciences Center, Denver Colorado
Thomas D. MacKenzie
Affiliation:
Department of Patient Safety and Quality, Denver Health and Hospital Authority, Denver, Colorado; and Department of Medicine, University of Colorado Health Sciences Center, Denver Colorado
Kendall K. Hall
Affiliation:
Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
Jon Mark Hirshon
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland National Study Center for Trauma and EMS, University of Maryland School of Medicine, Baltimore, Maryland Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background.

Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.

Objective.

To develop SNF-specific antibiograms and identify opportunities to improve antibiotic prescribing.

Design and Setting.

Cross-sectional and pretest-posttest study among residents of 3 Maryland SNFs.

Methods.

Antibiograms were created using clinical culture data from a 6-month period in each SNF. We also used admission clinical culture data from the acute care facility primarily associated with each SNF for transferred residents. We manually collected all data from medical charts, and antibiograms were created using WHONET software. We then used a pretest-posttest study to evaluate the effectiveness of an antibiogram on changing antibiotic prescribing practices in a single SNF. Appropriate empirical antibiotic therapy was defined as an empirical antibiotic choice that sufficiently covered the infecting organism, considering antibiotic susceptibilities.

Results.

We reviewed 839 patient charts from SNF and acute care facilities. During the initial assessment period, 85% of initial antibiotic use in the SNFs was empirical, and thus only 15% of initial antibiotics were based on culture results. Fluoroquinolones were the most frequently used empirical antibiotics, accounting for 54.5% of initial prescribing instances. Among patients with available culture data, only 35% of empirical antibiotic prescribing was determined to be appropriate. In the single SNF in which we evaluated antibiogram effectiveness, prevalence of appropriate antibiotic prescribing increased from 32% to 45% after antibiogram implementation; however, this was not statistically significant (P = .32).

Conclusions.

Implementation of antibiograms may be effective in improving empirical antibiotic prescribing in SNFs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S56 - S61
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Dwyer, LL, Harris-Kojetin, LD, Valverde, RH, et al. Infections in long-term care populations in theUnited States. J Am Geriatr Soc 2013;61(3):342–349.Google Scholar
2. Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21(10):674–679.Google Scholar
3. Boockvar, KS, Gruber-Baldini, AL, Burton, L, Zimmerman, S, May, C, Magaziner, J. Outcomes of infection in nursing home residents with and without early hospital transfer. J Am Geriatr Soc 2005; 53(4):590–596.CrossRefGoogle ScholarPubMed
4. Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008;29(9):785–814.CrossRefGoogle ScholarPubMed
5. Nicolle, LE. Antimicrobial stewardship in long term care facilities: what is effective? Antimicrob Resist Infect Control 2014;3(1):6–2994-3-6.Google Scholar
6. Stone, ND, Ashraf, MS, Calder, J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012;33(10):965–977.Google Scholar
7. Fleming, A, Browne, J, Byrne, S. The effect of interventions to reduce potentially inappropriate antibiotic prescribing in long-term care facilities: a systematic review of randomisedcontrolled trials. Drugs Aging 2013;30(6):401–408.Google Scholar
8. Hirshon, JM, Comer, AC, Rosenberg, JH, et al. Methodological challenges associated with developing and implementing antibiograms in nursing homes. In: Battles, JB, Cleeman, JI, Kahn, KL, Weinberg, DA, eds. Advances in the Prevention and Control of HAIs. Rockville, MD: Agency for Healthcare Research and Quality, 2014. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-hai/hai-article9.html. Accessed August 22, 2014.Google Scholar
9. University of Maryland Baltimore Gerontology Programs. Maryland long-term care project, http://gerontology.umaryland.edu/longterm.html. Updated 2013. Accessed August 22, 2014.Google Scholar
10. World Health Organization (WHO). WHONET software. http://www.who.int/drugresistance/whonetsoftware/en/. Updated 2011. Accessed August 22, 2014.Google Scholar
11. Clinical Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. 2011. CLSI document M100-S21.Google Scholar
12. Loeb, M, Brazil, K, Lohfeld, L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ 2005;331(7518):669.Google Scholar
13. Monette, J, Miller, MA, Monette, M, et al. Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities. J Am Geriatr Soc 2007;55(8):1231–1235.Google Scholar
14. Pettersson, E, Vernby, A, Molstad, S, Lundborg, CS. Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residents? a cluster randomized controlled trial. J Antimicrob Chemother 2011;66(11):2659–2666.CrossRefGoogle ScholarPubMed
15. Naughton, BJ, Mylotte, JM, Ramadan, F, Karuza, J, Priore, RL. Antibiotic use, hospital admissions, and mortality before and after implementing guidelines for nursing home-acquired pneumonia. J Am Geriatr Soc 2001;49(8):1020–1024.Google Scholar
16. Roup, BJ, Roche, JC, Pass, M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006;34(3):122–127.Google Scholar
17. Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Perencevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38(111:1586–1591.Google Scholar
18. Harris, AD, Lautenbach, E, Perencevich, E. A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance. Clin Infect Dis 2005;41(1):77–82.Google Scholar
19. Shardell, M, Harris, AD, El-Kamary, SS, Furuno, JP, Miller, RR, Perencevich, EN. Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies. Clin Infect Dis 2007;45(7):901–907.Google Scholar