Skip to main content
×
Home

Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities

  • Jon P. Furuno (a1), Angela C. Comer (a2) (a3), J. Kristie Johnson (a2) (a4), Joseph H. Rosenberg (a2), Susan L. Moore (a5), Thomas D. MacKenzie (a5), Kendall K. Hall (a6) and Jon Mark Hirshon (a2) (a3) (a7)...
Abstract
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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities
      Available formats
      ×
Copyright
References
Hide All
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):342349.
2.Strausbaugh LJ, Joseph CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21(10):674679.
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):590596.
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):785814.
5.Nicolle LE. Antimicrobial stewardship in long term care facilities: what is effective? Antimicrob Resist Infect Control 2014;3(1):62994-3-6.
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):965977.
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):401408.
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.
9.University of Maryland Baltimore Gerontology Programs. Maryland long-term care project, http://gerontology.umaryland.edu/longterm.html. Updated 2013. Accessed August 22, 2014.
10.World Health Organization (WHO). WHONET software. http://www.who.int/drugresistance/whonetsoftware/en/. Updated 2011. Accessed August 22, 2014.
11.Clinical Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. 2011. CLSI document M100-S21.
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.
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):12311235.
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):26592666.
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):10201024.
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):122127.
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(111:15861591.
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):7782.
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):901907.
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

Full text views

Total number of HTML views: 0
Total number of PDF views: 99 *
Loading metrics...

Abstract views

Total abstract views: 121 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.