scholarly journals Antibiotic Prescribing Choices and Their Comparative C. Difficile Infection Risks: A Longitudinal Case-Cohort Study

2020 ◽  
Author(s):  
Kevin Antoine Brown ◽  
Bradley Langford ◽  
Kevin L Schwartz ◽  
Christina Diong ◽  
Gary Garber ◽  
...  
Keyword(s):  
Nursing Home ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Nursing Home Residents ◽  
Quantitative Information ◽  
Antibiotic Prescribing ◽  
Adjusted Relative Risk ◽  
Increased Risk ◽  
Antibiotic Duration ◽  
Antibiotic Courses

Abstract Background Antibiotic use is the strongest modifiable risk factor for the development of Clostridioides difficile infection, but prescribers lack quantitative information on comparative risks of specific antibiotic courses. Our objective was to estimate risks of C. difficile infection associated with receipt of specific antibiotic courses. Methods We conducted a longitudinal case-cohort analysis representing over 90% of Ontario nursing home residents, between 2012 and 2017. Our primary exposure was days of antibiotic receipt in the prior 90 days. Adjustment covariates included: age, sex, prior emergency department or acute care stay, Charlson comorbidity index, prior C. difficile infection, acid suppressant use, device use, and functional status. We examined incident C. difficile infection, including cases identified within the nursing home, and those identified during subsequent hospital admissions. Adjusted and unadjusted regression models were used to measure risk associated with 5- to 14-day courses of 18 different antibiotics. Results We identified 1708 cases of C. difficile infection (1.27 per 100 000 resident-days). Longer antibiotic duration was associated with increased risk: 10- and 14-day courses incurred 12% (adjusted relative risk [ARR] = 1.12, 95% confidence interval [CI]: 1.09, 1.14) and 27% (ARR = 1.27, 95% CI: 1.21,1.30) more risk compared to 7-day courses. Among 7-day courses with similar indications: moxifloxacin resulted in 121% more risk than amoxicillin (ARR = 2.21, 95% CI: 1.67, 3.08), ciprofloxacin engendered 89% more risk than nitrofurantoin (ARR = 1.89, 95% CI: 1.45, 2.68), and clindamycin resulted in 112% (ARR = 2.12, 95% CI: 1.32, 3.78) more risk than cloxacillin. Conclusions C. difficile infection risk increases with antibiotic duration, and there are wide disparities in risks associated with antibiotic courses used for similar indications.

scholarly journals 299 A Retrospective Review of Unscheduled Hospital Admissions of Nursing Home Residents Over a Two Year Period

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Aoife McFeely ◽  
Cliona Small ◽  
Susie Hyland ◽  
Jonathan O'Keeffe ◽  
Graham Hughes ◽  
...  
Keyword(s):  
Nursing Home ◽  
Older People ◽  
Hospital Admissions ◽  
Nursing Home Residents ◽  
Integrated Approach ◽  
Care Team ◽  
Similar Data ◽  
Readmission Rates ◽  
Increased Risk ◽  
One Year

Abstract Background Older people living in Nursing Homes (NHs) represent a frail and vulnerable group. With multiple co-morbidities they are at increased risk of acute health deterioration prompting urgent hospital transfer. Our aim was to examine the outcomes for nursing home residents following unscheduled hospital attendances. Methods A prospective database was collected between 1 January 2016 and 31 December 2017. This recorded all emergency admissions of older people from NHs. The data was retrospectively analysed. Outcomes assessed included: length of stay (LOS), 30-day readmission rates, number of readmissions within one year and mortality. We compared these results to similar data collected in 2012-13. Results Over a two-year period, there were 1435 hospital admissions; a 7% increase from 1015 in 2012. 60% were female and 40% male with a mean age of 84.7 years. The average LOS was 9.58 days (vs 11.2 days in 2012-13). The 30-day readmission rate was 9.8% (vs 14% in 2012-13). 30.45% of all patients went on to have 2 or more readmissions within one year, an increase from 21.1% in 2012-13. The total in-hospital mortality was 14%. Conclusion An increase in the number of NH residents presenting to an acute hospital over the past 5 years was observed. Despite this, we have seen reductions in average LOS and 30 day readmission rates. There is, however, an increasing number of recurrent admissions (≥ 2) to the hospital within one year. These results highlight the importance of an integrated approach to patient care; from the primary care team, hospital team, palliative and community care services. We believe the continued development of Nursing Home Outreach Programmes and community liaison services, combined with the evolving role of the in-hospital Geriatric ANP and liaison palliative care team, will help reduce inappropriate ED referrals and encourage advanced care planning.

scholarly journals Antibiotic Susceptibility of Common Organisms Isolated from Urine Cultures of Nursing Home Residents

2020 ◽  
Vol 41 (S1) ◽  
pp. s118-s120
Author(s):  
Austin R. Penna ◽  
Taniece R. Eure Eure ◽  
Nimalie D. Stone ◽  
Grant Barney ◽  
Devra Barter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Susceptibility ◽  
Clinical Decision Making ◽  
Service Providers ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Prescribing ◽  
E Coli ◽  
Susceptibility Data

Background: With the emergence of antibiotic resistant threats and the need for appropriate antibiotic use, laboratory microbiology information is important to guide clinical decision making in nursing homes, where access to such data can be limited. Susceptibility data are necessary to inform antibiotic selection and to monitor changes in resistance patterns over time. To contribute to existing data that describe antibiotic resistance among nursing home residents, we summarized antibiotic susceptibility data from organisms commonly isolated from urine cultures collected as part of the CDC multistate, Emerging Infections Program (EIP) nursing home prevalence survey. Methods: In 2017, urine culture and antibiotic susceptibility data for selected organisms were retrospectively collected from nursing home residents’ medical records by trained EIP staff. Urine culture results reported as negative (no growth) or contaminated were excluded. Susceptibility results were recorded as susceptible, non-susceptible (resistant or intermediate), or not tested. The pooled mean percentage tested and percentage non-susceptible were calculated for selected antibiotic agents and classes using available data. Susceptibility data were analyzed for organisms with ≥20 isolates. The definition for multidrug-resistance (MDR) was based on the CDC and European Centre for Disease Prevention and Control’s interim standard definitions. Data were analyzed using SAS v 9.4 software. Results: Among 161 participating nursing homes and 15,276 residents, 300 residents (2.0%) had documentation of a urine culture at the time of the survey, and 229 (76.3%) were positive. Escherichia coli, Proteus mirabilis, Klebsiella spp, and Enterococcus spp represented 73.0% of all urine isolates (N = 278). There were 215 (77.3%) isolates with reported susceptibility data (Fig. 1). Of these, data were analyzed for 187 (87.0%) (Fig. 2). All isolates tested for carbapenems were susceptible. Fluoroquinolone non-susceptibility was most prevalent among E. coli (42.9%) and P. mirabilis (55.9%). Among Klebsiella spp, the highest percentages of non-susceptibility were observed for extended-spectrum cephalosporins and folate pathway inhibitors (25.0% each). Glycopeptide non-susceptibility was 10.0% for Enterococcus spp. The percentage of isolates classified as MDR ranged from 10.1% for E. coli to 14.7% for P. mirabilis. Conclusions: Substantial levels of non-susceptibility were observed for nursing home residents’ urine isolates, with 10% to 56% reported as non-susceptible to the antibiotics assessed. Non-susceptibility was highest for fluoroquinolones, an antibiotic class commonly used in nursing homes, and ≥ 10% of selected isolates were MDR. Our findings reinforce the importance of nursing homes using susceptibility data from laboratory service providers to guide antibiotic prescribing and to monitor levels of resistance.Disclosures: NoneFunding: None

Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 073346482110182
Author(s):  
Sainfer Aliyu ◽  
Jasmine L. Travers ◽  
S. Layla Heimlich ◽  
Joanne Ifill ◽  
Arlene Smaldone
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Antibiotic Stewardship ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Meta Analyses

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

scholarly journals Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents

2017 ◽  
Vol 38 (8) ◽  
pp. 998-1001 ◽  
Author(s):  
Taniece Eure ◽  
Lisa L. LaPlace ◽  
Richard Melchreit ◽  
Meghan Maloney ◽  
Ruth Lynfield ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Nursing Home ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Nursing Home Residents ◽  
Infect Control Hosp ◽  
Antibiotic Prescribing ◽  
Appropriate Use ◽  
Tract Infections

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH.Infect Control Hosp Epidemiol 2017;38:998–1001

Development of MDS-Based Predication Model for COPD Severity in Nursing Home Residents

2021 ◽  
pp. 106002802110592
Author(s):  
Barbara Blaylock ◽  
Xiaoli Niu ◽  
H. Edward Davidson ◽  
Stefan Gravenstein ◽  
Ronald DePue ◽  
...  
Keyword(s):  
Nursing Home ◽  
Treatment Guidelines ◽  
Cohort Analysis ◽  
Nursing Home Residents ◽  
Chronic Obstructive ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Treatment Pathways ◽  
Selection Of Variables ◽  
Long Acting

Background Assessing chronic obstructive pulmonary disease (COPD) severity is challenging in nursing home (NH) residents due to incomplete symptom assessments and exacerbation history. Objective The objective of this study was to predict COPD severity in NH residents using the Minimum Data Set (MDS), a clinical assessment of functional capabilities and health needs. Methods A cohort analysis of prospectively collected longitudinal data was conducted. Residents from geographically varied Medicare-certified NHs with age ≥60 years, COPD diagnosis, and ≥6 months NH residence at enrollment were included. Residents with severe cognitive impairment were excluded. Demographic characteristics, medical history, and MDS variables were extracted from medical records. The care provider–completed COPD Assessment Test (CAT) and COPD exacerbation history were used to categorize residents by Global Initiative for Chronic Lung Disease (GOLD) A to D groups. Multivariate multinomial logit models mapped the MDS to GOLD A to D groups with stepwise selection of variables. Results Nursing home residents (N = 175) were 64% women and had a mean age of 77.9 years. Among residents, GOLD B was most common (A = 13.1%; B = 44.0%; C = 5.7%; D = 37.1%). Any long-acting bronchodilator (LABD) use and any dyspnea were significant predictors of GOLD A to D groups. The predicted MDS-GOLD group (A = 6.9%; B = 52.6%; C = 4.6%; D = 36.0%) showed good model fit (correctly predicted = 60.6%). Nursing home residents may underuse group-recommended LABD treatment (no LABD: B = 53.2%; C = 80.0%; D = 40.0%). Conclusion and Relevance The MDS, completed routinely for US NH residents, could potentially be used to estimate COPD severity. Predicted COPD severity with additional validation could provide a map to evidence-based treatment guidelines and may help to individualize treatment pathways for NH residents.

scholarly journals Paramedics’ Perspectives on the Hospital Transfers of Nursing Home Residents—A Qualitative Focus Group Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3778
Author(s):  
Alexandra Pulst ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann ◽  
Guido Schmiemann
Keyword(s):  
Nursing Home ◽  
Nursing Staff ◽  
Hospital Admissions ◽  
Urinary Catheter ◽  
Nursing Home Residents ◽  
Point Of View ◽  
Focus Group Study ◽  
Professional Groups ◽  
Catheter Complications ◽  
Ed Visits

Emergency department (ED) visits and hospital admissions are common among nursing home residents (NHRs). Little is known about the perspectives of emergency medical services (EMS) which are responsible for hospital transports. The aim of this study was to explore paramedics’ experiences with transfers from nursing homes (NHs) and their ideas for possible interventions that can reduce transfers. We conducted three focus groups following a semi-structured question guide. The data were analyzed by content analysis using the software MAXQDA. In total, 18 paramedics (mean age: 33 years, male n = 14) participated in the study. Paramedics are faced with complex issues when transporting NHRs to hospital. They mainly reported on structural reasons (e.g., understaffing or lacking availability of physicians), which led to the initiation of an emergency call. Handovers were perceived as poorly organized because required transfer information (e.g., medication lists, advance directives (ADs)) were incomplete or nursing staff was insufficiently prepared. Hospital transfers were considered as (potentially) avoidable in case of urinary catheter complications, exsiccosis/infections and falls. Legal uncertainties among all involved professional groups (nurses, physicians, dispatchers, and paramedics) seemed to be a relevant trigger for hospital transfers. In paramedics’ point of view, emergency standards in NHs, trainings for nursing staff, the improvement of working conditions and legal conditions can reduce potentially avoidable hospital transfers from NHs.

scholarly journals Physical performance trajectories and mortality among nursing home residents: results of the SENIOR cohort

2020 ◽  
Vol 49 (5) ◽  
pp. 800-806 ◽  
Author(s):  
Alexia Charles ◽  
Johann Detilleux ◽  
Fanny Buckinx ◽  
Jean-Yves Reginster ◽  
Bastien Gruslin ◽  
...  
Keyword(s):  
Nursing Home ◽  
Older People ◽  
Physical Performance ◽  
Nursing Home Residents ◽  
Value Added ◽  
Growth Curve Analysis ◽  
Risk Of Mortality ◽  
Slow Decline ◽  
Increased Risk ◽  
Fast Decline

Abstract Background Previous studies have shown that older people can experience a considerable change in their physical performance (PP) over time. Objectives To identify PP trajectories and their association with mortality among nursing home residents who were followed up for 3 years. Design Three-year longitudinal observational study. Setting Subjects of the SENIOR cohort. Subjects Six hundred and four nursing home residents with a mean age of 82.9 ± 9.1 years. Methods Baseline characteristics and the date of death were collected from the medical records. PP was assessed annually by the short physical performance battery (SPPB) test. Multiple imputations were performed to manage the missing data. PP trajectory groups were estimated using latent growth curve analysis. Cox proportional hazard regression models were applied to examine the risk of mortality according to the PP trajectory groups. Results Three PP trajectory groups were identified: slow decline (N = 96), moderate decline (N = 234) and fast decline (N = 274). After adjustments for potential confounding variables and the baseline SPPB scores, the residents in the fast decline and moderate decline trajectory groups had an increased risk of mortality compared to those in the slow decline trajectory group, with hazard ratio values of 1.78 (95% confidence interval [CI] = 1.34–2.26) and 1.37 (95% CI = 1.10–1.66), respectively. Conclusions PP trajectories provide value-added information to baseline geriatric assessments and could be used for predicting 3-year mortality among nursing home residents. It may be important to regularly monitor the SPPB score and signal an alert when a fast decline in PP is detected in older people.

scholarly journals The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection

2019 ◽  
Vol 70 (8) ◽  
pp. 1620-1627 ◽  
Author(s):  
Kevin Antoine Brown ◽  
Nick Daneman ◽  
Kevin L Schwartz ◽  
Bradley Langford ◽  
Allison McGeer ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Regression Models ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Before And After

Abstract Background Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. Methods We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering &gt;90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. Results A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18–1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28–1.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07–1.31). Conclusions Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection.

Odds of Venous Thromboembolims (VTE) Associated with Hospitalization, Surgery, and Cancer Among Nursing Home Residents: A Population-Based Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2984-2984
Author(s):  
Cynthia L. Leibson ◽  
John A. Heit ◽  
Kent R. Bailey ◽  
Tanya M. Petterson ◽  
Aneel Ashrani
Keyword(s):  
Nursing Home ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Conflicts Of Interest ◽  
Conditional Logistic Regression ◽  
Nursing Home Residents ◽  
Population Based ◽  
Olmsted County ◽  
Increased Risk ◽  
Active Cancer

Abstract Abstract 2984 Poster Board II-960 In previous studies of venous thromboembolism (VTE) among all residents of Olmsted County, MN, the odds of VTE associated with surgery, medical hospitalization, or active cancer were extremely high (Univariate odds ratio [OR] =14.6; 4.6, and 8.4 respectively). We also showed that nursing home (NH) residency was an independent risk factor for VTE (OR =5.6). From a clinical practice perspective, it is important to identify which NH residents are at risk of VTE. While it might be assumed that, similar to estimates for the population generally, surgery, medical hospitalization, and cancer are associated with increased risk of VTE within the NH population, the answer remains unclear. We took advantage of the previous identification of all Olmsted County, MN residents who met research criteria for incident VTE 1998-2005 (N=1168). We then determined which individuals were resident of a local NH at time of symptom onset, regardless of location of symptom onset (i.e., for purposes of this study, individuals whose VTE occurred in-hospital having been admitted from a NH were considered NH residents). For each such NH VTE case (N=96), we identified 2 same sex Olmsted County residents of similar age and duration-of-medical-history who were resident of a local NH at the time of the case's VTE event (i.e., index date) (N=192). The detailed provider-linked medical records of NH VTE cases and NH non-VTE controls were reviewed for 3 months before index for surgery or medical hospitalization and for 6 months surrounding index for active cancer. Using conditional logistic regression, we tested and estimated the odds ratio associated with each of these potential risk factors. The proportions of NH VTE cases and NH non-VTE controls with surgery (33%, 28%), medical hospitalization (44%, 46%), and active cancer (12%, 9%) were similar. Univariate odds ratios (95% confidence intervals) and p values for surgery, medical hospitalization, and active cancer were 1.5 (0.7-3.1), p=0.30; 1.1 (0.6-2.1), p=0.74; and 1.4 (0.6-3.2), p=0.46 respectively. Compared to the entire Olmsted County population, the odds of VTE associated with surgery, hospitalization, and cancer are surprisingly much lower for NH residents. Additional investigation is needed to characterize the subset of NH residents at increased risk of VTE. Disclosures: No relevant conflicts of interest to declare.

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