Skip to main content Accesibility Help
×
×
Home

Effective Antimicrobial Stewardship in a Long-Term Care Facility through an Infectious Disease Consultation Service: Keeping a LID on Antibiotic Use

  • Robin L. P. Jump (a1) (a2) (a3), Danielle M. Olds (a4), Nasim Seifi (a1), Georgios Kypriotakis (a1) (a3), Lucy A. Jury (a1), Emily P. Peron (a5), Amy A. Hirsch (a3) (a6), Paul E. Drawz (a2) (a3), Brook Watts (a2) (a3), Robert A. Bonomo (a1) (a2) (a3) (a7) (a8) and Curtis J. Donskey (a1) (a2) (a3) (a7)...
Abstract
Design.

We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.

Setting.

A 160-bed VA LTCF.

Methods.

Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.

Results.

Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P = .008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P = .04).

Conclusions.

Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.

Copyright
Corresponding author
GRECC 111C(W), Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106 (robinjump@gmail.com)
References
Hide All
1. Jones, AL, Dwyer, LL, Bercovitz, AR, Strahan, GW. The National Nursing Home Survey: 2004 overview. Vital Health Stat 2009;167:1155.
2. National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD: National Center for Health Statistics, 2011.
3. US Census Bureau Public Information Office. An older and more diverse nation by midcentury. Release CB08-123, http://www.census.gov/newsroom/releases/archives/population/cb08-123.html. Published August 14, 2008. Accessed March 7, 2012.
4. Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21(10):674679.
5. Strausbaugh, LJ. Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 2001;7(2):268271.
6. Juthani-Mehta, M, Quagliarello, VJ. Infectious diseases in the nursing home setting: challenges and opportunities for clinical investigation. Clin Infect Dis 2010;51(8):931936.
7. Trick, WE, Weinstein, RA, DeMarais, PL, et al. Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 2001;49(3):270276.
8. Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RLP, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45(8):992998.
9. Nicolle, LE, Bendey, DW, Garibaldi, R, Neuhaus, EG, Smith, PW. Antimicrobial use in long-term–care facilities. Infect Control Hosp Epidemiol 2000;21(8):537545.
10. Peron, EP, Hirsch, AA, Jump, RLP, Donskey, CJ. Don't let the steward sail without us: high rate of unnecessary antimicrobial use in long-term care facility. Paper presented at: 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 12–15, 2010; Boston, MA.
11. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guide-lines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31(5):431455.
12. Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile–associated disease. Emerg Infect Dis 2006;12(10):15761579.
13. Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27(4):299309.
14. Judge, GG, Griffiths, WE, Hill, RC, Lee, TC. The Theory and Practice of Econometrics. New York: Wiley, 1980.
15. Jump, RLP, Riggs, MM, Sethi, AK, et al. Multihospital outbreak of Clostridium difficile infection, Cleveland, Ohio, USA. Emerg Infect Dis 2010;16(5):827829, http://wwwnc.cdc.gov/eid/article/16/5/07-1606_article.htm.
16. Jury, LA, Jump, RLP, Sitzlar, B, Guerrero, DM, Donskey, CJ. Improved diagnosis and treatment of Clostridium difficile infection in a long-term care facility after initiation of an on-site infectious disease consultation service. Paper presented at: 21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA); April 2, 2011; Dallas, TX. Abstract 90.
17. Schwartz, DN, Abiad, H, DeMarais, PL, et al. An educational intervention to improve antimicrobial use in a hospital-based long-term care facility. J Am Geriatr Soc 2007;55(8):12361242.
18. 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):12311235.
19. Loeb, M. 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):669670.
20. Zabarsky, TF, Sethi, AK, Donskey, CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control 2008;36(7):476480.
21. Benoit, SR, Nsa, W, Richards, CL, et al. Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc 2008;56(11):20392044.
22. Mylotte, JM. Measuring antibiotic use in a long-term care facility. Am J Infect Control 1996;24(3):174179.
23. Johnson, S, Samore, MH, Farrow, KA, et al. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999;341(22):16451651.
24. Loo, VG, Poirier, L, Miller, MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353(23):24422449.
25. Polk, RE, Hohmann, SF, Medvedev, S, Ibrahim, O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53(11):11001110.
26. Caprio, TV, Karuza, J, Katz, PR. Profile of physicians in the nursing home: time perception and barriers to optimal medical practice. J Am Med Dir Assoc 2009;10(2):9397.
27. Dellit, TH, Owens, RC, McGowan, JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44(2):159177.
28. VanSchooneveld, TV, Miller, H, Sayles, H, Watkins, K, Smith, PW. Survey of antimicrobial stewardship practices in Nebraska long-term care facilities. Infect Control Hosp Epidemiol 2011;32(7):732734.
29. Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility. Am J Infect Control 2008;36(7):504535.
30. Smith, PW, Watkins, K, Miller, H, VanSchooneveld, T. Antibiotic stewardship programs in long-term care facilities. Ann Long-Term Care Clin Care Aging 2011;19(4):2025.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed