scholarly journals Outcomes of a Provincial Pilot Program to Reduce Unnecessary Urine Culturing and Antibiotic Overuse in Long-term Care

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S62-S63
Author(s):  
Kevin Brown ◽  
Andrea Chambers ◽  
Valerie Leung ◽  
Bradley Langford ◽  
Jacquelyn Quirk ◽  
...  
Keyword(s):  
Organizational Change ◽  
Long Term Care ◽  
Planning Process ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Outcome Evaluation ◽  
Term Care ◽  
Implementation Phase ◽  
Implementation Period

Abstract Background Antibiotics are frequently prescribed for long-term care residents with asymptomatic bacteriuria, for which there is no indication. In order to help reduce unnecessary urine culturing and concomitant antibiotic use, C. difficile infection, and antibiotic resistance, Public Health Ontario (PHO) developed a multi-component organizational change program. The program focuses on five practice changes, recommends nine implementation strategies that have been linked to barriers, and includes an implementation planning process. Methods A purposive sampling strategy was used to recruit 12 long-term care homes (LTCHs) in the province of Ontario, Canada. LTCHs worked with PHO staff to implement the program over a 4-month period in mid-2016. The outcome evaluation compared rates of urine cultures sent, total antibiotics, and urinary antibiotics (ciprofloxacin, nitrofurantoin, TMP/SMX, and fosfomycin) per 1,000 resident days before and after the implementation phase. A Poisson regression model adjusting for time-trends, seasonality and controlling for autocorrelation, was used. Results Of the 12 LTCHs recruited, as of May 2017, 9 LTCHs provided data, totaling 106 facility-months. During the pre-implementation phase, inter-facility variation in urine culturing rates (mean = 2.4, inter-decile range [IDR] = 4.3), total antibiotic use (median = 3.2, IDR = 5.5), and urinary antibiotic use (median = 1.2, IDR = 2.2), were large (Figure 1). Comparing the post-implementation period to the pre-implementation period, we observed a 31% adjusted decline in urine culturing (incidence rate ration [IRR] = 0.69, 95% CI: 0.51 to 0.94, Figure 2), a 65% adjusted decline in total antibiotic use (IRR = 0.35, 95% CI: 0.13 to 0.92), and a 38% adjusted decline in urinary antibiotic use (IRR = 0.62, 95% CI: 0.23 to 1.68) across the participating facilities. Conclusion While there was variation in baseline urine culturing rates and antibiotic use across LTCHs, preliminary data indicate that these outcomes declined in a relatively short time period following implementation of an organizational change program. Plans to expand the program to the provinces 600 LTCHs could prioritize facilities with high baseline urine culturing rates. Disclosures All authors: No reported disclosures.

Infections and use of antibiotics in residents of long-term care facilities in Hungary

2014 ◽  
Vol 155 (23) ◽  
pp. 911-917 ◽  
Author(s):  
Rita Szabó ◽  
Karolina Böröcz
Keyword(s):  
Urinary Tract ◽  
Long Term Care ◽  
Soft Tissues ◽  
Good Practice ◽  
Antibiotic Use ◽  
Prevalence Survey ◽  
Term Care ◽  
Care Facilities ◽  
Tract Infections

Introduction: Healthcare associated infections and antimicrobial use are common among residents of long-term care facilities. Faced to the lack of standardized data, the European Centre for Disease Prevention and Control funded a project with the aim of estimating prevalence of infections and antibiotic use in European long-term care facilities. Aim: The aim of the authors was to present the results of the European survey which were obtained in Hungary. Method: In Hungary, 91 long-term care facilities with 11,823 residents participated in the point-prevalence survey in May, 2013. Results: The prevalence of infections was 2.1%. Skin and soft tissues infections were the most frequent (36%), followed by infections of the respiratory (30%) and urinary tract (21%). Antimicrobials were mostly prescribed for urinary tract infections (40.3%), respiratory tract infections (38.4%) and skin and soft tissue infections (13.2%). The most common antimicrobials (97.5%) belonged to the ATC J01 class of “antibacterials for systemic use”. Conclusions: The results emphasise the need for a national guideline and education for good practice in long-term care facilities. Orv. Hetil., 2014, 155(23), 911–917.

Changes in antibiotic use following implementation of a telehealth stewardship pilot program

2019 ◽  
Vol 40 (7) ◽  
pp. 810-814 ◽  
Author(s):  
Brigid M. Wilson ◽  
Richard E. Banks ◽  
Christopher J. Crnich ◽  
Emma Ide ◽  
Roberto A. Viau ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Term Care ◽  
Medical Centers ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Veterans Affairs Medical Centers

AbstractStarting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.

Antibiotic Use in Long-Term–Care Facilities: Many Unanswered Questions

2000 ◽  
Vol 21 (10) ◽  
pp. 680-683 ◽  
Author(s):  
Mark Loeb
Keyword(s):  
Antibiotic Resistance ◽  
Long Term Care ◽  
Diagnostic Testing ◽  
Antibiotic Use ◽  
Quantitative Relation ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Term Care ◽  
Care Facilities

AbstractThe extensive use of antibiotics in long-term–care facilities has led to increasing concern about the potential for the development of antibiotic resistance. Relatively little is known, however, about the quantitative relation between antibiotic use and resistance in this population. A better understanding of the underlying factors that account for variance in antibiotic use, unexplained by detected infections, is needed. To optimize antibiotic use, evidence-based standards for empirical antibiotic prescribing need to be developed. Limitations in current diagnostic testing for infection in residents of long-term–care facilities pose a substantial challenge to developing such standards.

scholarly journals 73. Identification of Novel Factors Associated with Inappropriate Treatment of Asymptomatic Bacteriuria Treatment in Acute and Long-term Care

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S153-S154
Author(s):  
Marissa Valentine-King ◽  
John Van ◽  
Casey E Hines-Munson ◽  
Laura Dillon ◽  
Christopher J Graber ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Long Term Care ◽  
Asymptomatic Bacteriuria ◽  
Low Grade ◽  
Term Care ◽  
Factors Associated ◽  
Inappropriate Treatment ◽  
Sirs Criteria

Abstract Background Inappropriate treatment of asymptomatic bacteriuria (ASB) is a major driver of antibiotic overuse. Demographic and laboratory factors associated with inappropriate antibiotic treatment include older age, pyuria, leukocytosis and dementia. To gain a deeper understanding of inappropriate ASB treatment, we performed an in-depth review of provider documentation capturing a broader range of misleading factors associated with ASB treatment. Methods We reviewed a random sample of 10 positive urine cultures per month per facility from acute or long-term care wards at eight Veteran’s Administration (VA) facilities from 2017-2019 (n=960). Trained chart reviewers classified cultures as UTI or ASB and as treated or untreated. Charts were searched specifically for mention of 8 categories of potentially misleading symptoms that often lead to overtreatment of ASB (e.g. “prior history of UTI”) (Figure legend). We also created a ‘suspected systemic inflammatory response syndrome (SIRS)’ category that included any mention of leukocytosis, tachycardia, tachypnea, subjective or low-grade fever, or hypothermia. Generalized estimating equations logistic regression was used for analysis. Results Our study included 575 cultures from patients that were primarily white (71%) males (94%) from acute medicine units (75.7%) with a mean age of 76. Twenty-eight percent (n=159) of ASB cases received antibiotics. In addition to the usual known predictors, multiple new misleading symptoms were found to be associated with ASB treatment (Table). Novel, independent predictors of ASB treatment included behavioral issues, such as falls or fatigue (odds ratio (OR): 1.8; 95% CI: 1.05-3.07), urine characteristics, such as cloudy or odorous urine (OR: 1.41; 95% CI: 1.13-1.75), voiding issues (OR: 1.86; 95% CI: 1.43-2.41), and a single, free text mention of a SIRS criteria (OR: 1.63; 95% CI: 1.16-2.3). P-values extracted from multivariate regression model (ASB-asymptomatic bacteriuria; NS-not significant; SIRS- systemic inflammatory response syndrome). The following signs or symptoms compose each category: abnormal laboratory findings: acute kidney injury, abnormal creatinine, leukocytosis, pyuria/positive urinalysis, hyperglycemia; abnormal vital sign: bradycardia, tachycardia, atrial fibrillation, hypotension, hypertension, hypoxia, tachypnea, subjective fever or low-grade fever, syncope; behavior issues: falls, confusion lethargy, fatigue, weakness; nonspecific signs or symptoms: nonspecific gastrointestinal, genitourinary, neurological symptoms; voiding issues: decreased urine output, urinary retention, urinary incontinence; urine characteristics: change in color, foul smell, cloudy urine, sediment; SIRS: ordinal variable characterizing if 1 or ≥ 2 of the following were documented by the provider: leukocytosis, tachycardia, tachypnea, subjective or low-grade fever, hypothermia. Conclusion Our in-depth chart review, with attention to misleading symptoms and any documentation of the provider thought process, highlights new factors associated with inappropriate ASB treatment. Patients with even a single SIRS criteria are at risk for unnecessary treatment of ASB; this finding can help design antibiotic stewardship interventions. Disclosures Barbara Trautner, MD, PhD, Genentech (Consultant, Scientific Research Study Investigator)

scholarly journals 857. A Tele-Antibiotic Stewardship Program Influences Antibiotic Use at 2 Rural Veterans Affairs Medical Centers

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S19-S19
Author(s):  
Brigid Wilson ◽  
Richard Banks ◽  
Christopher Crnich ◽  
Emma Ide ◽  
Roberto Viau ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Term Care ◽  
Limited Access ◽  
Days Of Therapy ◽  
The Mean ◽  
Length Of Therapy

Abstract Background Telehealth offers the possibility of supporting antibiotic stewardship in settings with limited access to people with infectious diseases (ID) expertise. Previously, we described preliminary results from a pilot project that used the Veterans Affairs (VA) telehealth system to facilitate a Videoconference Antimicrobial Stewardship Team (VAST) which connected a multidisciplinary team from a rural VA medical center (VAMC) with ID physicians at a remote site to support antibiotic stewardship. Here, we present 3 distinct metrics to assess the influence of the VAST on antibiotic use at 2 intervention sites. Methods Outcomes assessed antibiotic use in the hospital and long-term care units of 2 rural VAMCs in the year before and after VAST implementation, allowing for a 1-month wash-in period in the first month of the VAST. Using VA databases, we determined 3 metrics: the rate of antibiotic use (days of therapy per 1,000 bed days of care); the mean length of therapy (days); and the mean patient antibiotic spectrum index (ASI), a measure of antibiotic spectrum increasing from narrow to broad. Using segmented regression on monthly measures of each metric with a knot at the wash-in month (gray square), we calculated predicted values (solid lines), and confidence intervals (dashed lines) to examine trends before (black squares) and after (white squares) implementing the VAST. Results The rate of antibiotic use, mean length of therapy, and ASI decreased at Site A. As indicated in the figure, the effect was more pronounced in long-term care compared with the hospital, where the VAST sustained but did not accelerate downward trends. At Site B, the most notable influence of the VAST was on the ASI for the hospital and long-term care units. Conclusion The VAST is a feasible, sustainable program that is effective at inducing change in antibiotic use at 2 VAMCs. The influence of the VAST differed between the 2 sites and, at Site A had a more pronounced effect on the long-term care compared with hospital units. These distinct metrics capture changes in overall antibiotic use, length of therapy, and agent selection. Tele-antibiotic stewardship programs hold potential to improve antibiotic use at facilities with limited access to people with antibiotic stewardship expertise. Disclosures All authors: No reported disclosures.

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