Antimicrobial stewardship programmes reduce antibiotic use in long-term care homes

2019 ◽  
Author(s):  
Keyword(s):  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Care Homes ◽  
Term Care

Antimicrobial Stewardship in Rhode Island Long-Term Care Facilities: Current Standings and Future Opportunities

2016 ◽  
Vol 37 (8) ◽  
pp. 979-982 ◽  
Author(s):  
Haley J. Morrill ◽  
Leonard A. Mermel ◽  
Rosa R. Baier ◽  
Nicole Alexander-Scott ◽  
David Dosa ◽  
...  
Keyword(s):  
Rhode Island ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Infect Control Hosp ◽  
Term Care ◽  
Care Facilities ◽  
Infection Preventionists

Our survey of antimicrobial stewardship practices among Rhode Island long-term care facilities demonstrated opportunities to develop formal programs. Results suggest infection preventionists are largely responsible for ensuring appropriate antibiotic use in long-term care facilities and there is a need for increased interdisciplinary access to individuals with antimicrobial stewardship expertise.Infect Control Hosp Epidemiol 2016;37:979–982

scholarly journals Impact of Training Consultant Pharmacists on Antimicrobial Stewardship Programs in Long-Term Care Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s446-s448
Author(s):  
Muhammad Salman Ashraf ◽  
Philip Chung ◽  
Alex Neukirch ◽  
Scott Bergman ◽  
R. Jennifer Cavalieri ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Repeated Measures ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Rank Test ◽  
Term Care ◽  
Days Of Therapy ◽  
Care Facilities ◽  
Core Elements

Background: The CDC recommends that consultant pharmacists support antimicrobial stewardship programs (ASPs) in long-term care facilities (LTCFs). We studied CDC-recommended ASP core elements implementation and antibiotic use in LTCFs before and after training consultant pharmacists. Methods: Between August 2017 and October 2017, consultant pharmacists from a regional long-term care pharmacy attended 5 didactic sessions preparing them to assist LTCFs in implementation of CDC-recommended ASP core elements. Training also included creating a process for evaluating appropriateness of all systemic antibiotics and providing prescriber feedback during their monthly mandatory drug-regimen reviews. Once monthly “meet-the-expert” sessions were held with consultant pharmacists throughout the project (November 2017 to December 2018). LTCF enrollment began in November 2017 and >90% of facilities joined by January 2018. After enrollment, consultant pharmacists initiated ASP interventions including antibiotic reviews and feedback using standard templates. They also held regular meetings with infection preventionists to discuss Core Elements implementation and provided various ASP resources to LTCFs (eg, antibiotic policy template, guidance documents and standard assessment and communication tools). Data collection included ASP Core Elements, antibiotic starts, days of therapy (DOT), and resident days (RD). The McNemar test, the Wilcoxon signed-rank test, generalized estimating equation model, and the classic repeated measures approach were used to compare the presence of all 7 core elements and antibiotic use during the baseline (2017) and intervention (2018) year.Results: In total, 9 trained consultant pharmacists assisted 32 LTCFs with ASP implementation. When evaluating 27 LTCFs that provided complete data, a significant increase in presence of all 7 Core Elements after the intervention was noted compared to baseline (67% vs 0; median Core Elements, 7 vs 2; range, 6–7 vs 1–6; P < .001). Median monthly antibiotic starts per 1,000 RD and DOT per 1,000 RD decreased in 2018 compared to 2017: 8.93 versus 9.91 (P < .01) and 106.47 versus 141.59 (P < .001), respectively. However, variations in antibiotic use were detected among facilities (Table 1). When comparing trends, antibiotic starts and DOT were already trending downward during 2017 (Fig. 1A and 1B). On average, antibiotic starts decreased by 0.27 per 1,000 RD (P < .001) and DOT by 1.92 per 1,000 RD (P < .001) each month during 2017. Although antibiotic starts remained mostly stable in 2018, DOT continued to decline further (average monthly decline, 2.60 per 1,000 RD; P < .001). When analyzing aggregated mean, antibiotic use across all sites per month by year, DOT were consistently lower throughout 2018 and antibiotic starts were lower for the first 9 months (Fig. 1C and 1D). Conclusions: Consultant pharmacists can play an important role in strengthening ASPs and in decreasing antibiotic use in LTCFs. Educational programs should be developed nationally to train long-term care consultant pharmacists in ASP implementation.Funding: Merck & Co., Inc, provided funding for this study.Disclosures: Muhammad Salman Ashraf and Scott Bergman report receipt of a research grant from Merck.

scholarly journals Determining Antibiotic Use in Long-Term Care Facilities Across Tennessee

2020 ◽  
Vol 41 (S1) ◽  
pp. s185-s186
Author(s):  
Cullen Adre ◽  
Youssoufou Ouedraogo ◽  
Christopher David Evans ◽  
Amelia Keaton ◽  
Marion Kainer
Keyword(s):  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
Term Care ◽  
Days Of Therapy ◽  
Care Facilities ◽  
Core Elements

Background: Antibiotic stewardship is an area of great concern in long-term care facilities nationwide. The CDC promotes 7 core elements of antimicrobial stewardship. Based on information obtained from the Infection Control Assessment and Response (ICAR) Program, the 2 core elements most infrequently achieved by LTCFs are tracking and reporting. Currently, minimal data are available on antibiotic use (AU) in LTCFs in Tennessee. To address both issues, the Tennessee Department of Health (TDH) developed a monthly antibiotic use (AU) point-prevalence (PP) survey to provide LTCFs with a free tool to both track and report their AU and to gather data on how LTCFs are using antibiotics. Methods: We used REDCap to create a questionnaire to collect information on selected antibiotics administered in Tennessee LTCFs. This self-administered survey was promoted through the TDH monthly antimicrobial stewardship and infection control (ASIC) call as well as at various conferences and speaking engagements across the state. Antimicrobial stewardship leads for each facility were targeted. Antibiotics were grouped into 4 classes according to their indications: C. difficile infections, urinary tract infections, skin and soft-tissue infections (SSTIs) and respiratory infections. We determined AU percentage by dividing the number of days of therapy for a drug by a facility’s average census. Individualized reports are provided to each participating facility on a quarterly basis. Results: Currently, 16 facilities have participated in the survey. Overall, 40.7% of antibiotics prescribed were in the common for SSTI category and 39.3% were common for respiratory infections. The top 33 most commonly prescribed antibiotics were amoxicillin (156 days of therapy [DOT]), nitrofurantoin (92 DOT), and levofloxacin (88 DOT). The average percentage of residents on antimicrobials on the day of survey was 12.3%; within this group, 57% of antibiotics were initiated in the LTCF, whereas 43% were present upon admission. Conclusions: Early results from the TDH AU PP survey revealed that drugs commonly used for SSTIs and respiratory infection were the most common antibiotic prescriptions and a potential area of focus for TDH’s antimicrobial stewardship efforts. None of the 3 most frequently prescribed antibiotics, however, fall under the SSTI indication, despite SSTI being the most commonly prescribed indication based on the survey’s evaluation metrics. This finding could be related to the larger number of antibiotics that fall under the SSTI indication. Preliminary data are being used to guide the direction of TDH’s future ASIC calls to better suit disease states, which have room for improvement.Funding: NoneDisclosures: None

scholarly journals Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

2015 ◽  
Vol 68 (6) ◽  
Author(s):  
Lisa Dong-Ying Wu ◽  
Sandra A N Walker ◽  
Marion Elligsen ◽  
Lesley Palmay ◽  
Andrew Simor ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Care Facility ◽  
Antibiotic Use ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Longue Duree ◽  
Longue Durée

<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> Antimicrobial stewardship may be important in long-term care facilities because of unnecessary or inappropriate antibiotic use observed in these residents, coupled with their increased vulnerability to health care–associated infections.</p><p><strong>Objectives:</strong> To assess antibiotic use in a long-term care facility in order to identify potential antimicrobial stewardship needs.</p><p><strong>Methods:</strong> A retrospective descriptive study was conducted at the Veterans Centre, a long-term care facility at Sunnybrook Health Sciences Centre, Toronto, Ontario. All residents taking one or more antibiotics (n = 326) were included as participants. Antibiotic-use data for patients residing in the facility between April 1, 2011, and March 31, 2012, were collected and analyzed.</p><p><strong>Results:</strong> Totals of 358 patient encounters, 835 antibiotic prescriptions, and 193 positive culture results were documented during the study period. For 36% (302/835) of antibiotic prescriptions, the duration was more than 7 days. Cephalosporins (30%; 251/835) and fluoroquinolones (28%; 235/835) were the most frequently prescribed antibiotic classes. Urine was the most common source of samples for culture (60%; 116/193).</p><p><strong>Conclusions:</strong> Characteristics of antimicrobial use at this long-term care facility that might benefit from further evaluation included potentially excessive use of fluoroquinolones and cephalosporins and potentially excessive duration of antibiotic use for individual patients.</p><p><strong>RÉSUMÉ</strong></p><p><strong></strong><strong>Contexte :</strong> La gérance des antibiotiques peut s’avérer importante au sein des établissements de soins de longue durée à cause d’une utilisation inutile ou inappropriée des antibiotiques chez les résidents de ces établissements et de leur vulnérabilité aux infections nosocomiales. </p><p><strong>Objectifs :</strong> Évaluer l’utilisation des antibiotiques dans un établissement de soins de longue durée afin de déterminer si une gérance des antimicrobiens peut être nécessaire.</p><p><strong>Méthodes :</strong> Une étude descriptive rétrospective a été réalisée au Veterans Centre, un établissement de soins de longue durée au sein du Sunnybrook Health Sciences Centre, à Toronto en Ontario. Tous les résidents prenant au moins un antibiotique (n = 326) ont été admis à l’étude. Des données sur les antibiothérapies pour des patients résidant dans l’établissement entre le 1er avril 2011 et le 31 mars 2012 ont été recueillies et analysées.</p><p><strong>Résultats :</strong> Pendant l’étude, on a consigné en tout 358 séjours de patients, 835 prescriptions d’antibiotiques et 193 résultats positifs de culture. Pour 36 % (302/835) des prescriptions d’antibiotiques, le traitement était de plus de 7 jours. Les céphalosporines (30 % [251/835]) et les fluoroquinolones (28 % [235/835]) étaient les antibiotiques les plus souvent prescrits. Les cultures étaient le plus souvent obtenues à partir d’urines (60 % [116/193]).</p><p><strong>Conclusions :</strong> L’utilisation possiblement excessive de fluoroquinolones et de céphalosporines ainsi que la durée potentiellement exagérée des antibiothérapies font partie des caractéristiques de l’emploi des antimicrobiens dans cet établissement de soins de longue durée qui pourraient mériter de plus amples évaluations.</p>

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.

scholarly journals The Impact of Enhanced Antimicrobial Stewardship Support on Antibiotic Starts in Long-Term Care Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s527-s527
Author(s):  
Gabriela Andujar-Vazquez ◽  
Kirthana Beaulac ◽  
Shira Doron ◽  
David R Snydman
Keyword(s):  
Public Health ◽  
Pilot Study ◽  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Medical Center ◽  
Term Care ◽  
Care Facilities ◽  
The Impact

Background: The Tufts Medical Center Antimicrobial Stewardship (ASP) Team has partnered with the Massachusetts Department of Public Health (MDPH) to provide broad-based educational programs (BBEP) to long-term care facilities (LTCFs) in an effort to improve ASP and infection control practices. LTCFs have consistently expressed interest in individualized and hands-on involvement by ASP experts, yet they lack resources. The goal of this study was to determine whether “enhanced” individualized guidance provided by an ASP expert would lead to antibiotic start decreases in LTCFs participating in our pilot study. Methods: A pilot study was conducted to test the feasibility and efficacy of providing enhanced ASP and infection control practices to LTCFs. In total, 10 facilities already participating in MDPH BBEP and submitting monthly antibiotic start data were enrolled, were stratified by bed size and presence of dementia unit, and were randomized 1:1 to the “enhanced” group (defined as reviewing protocols and antibiotic start cases, providing lectures and feedback to staff and answering questions) versus the “nonenhanced” group. Antibiotic start data were validated and collected prospectively from January 2018 to July 2019, and the interventions began in April 2019. Due to staff turnover and lack of engagement, intervention was not possible in 2 of the 5 LTCFs randomized to the enhanced group, which were therefore analyzed as a nonenhanced group. An incidence rate ratios (IRRs) with 95% CIs were calculated comparing the antibiotic start rate per 1,000 resident days between periods in the pilot groups. Results: The average bed sizes for enhanced groups versus nonenhanced groups were 121 (±71.0) versus 108 (±32.8); the average resident days per facility per month were 3,415.7 (±2,131.2) versus 2,911.4 (±964.3). Comparatively, 3 facilities in the enhanced group had dementia unit versus 4 in the nonenhanced group. In the per protocol analysis, the antibiotic start rate in the enhanced group before versus after the intervention was 11.35 versus 9.41 starts per 1,000 resident days (IRR, 0.829; 95% CI, 0.794–0.865). The antibiotic start rate in the nonenhanced group before versus after the intervention was 7.90 versus 8.23 antibiotic starts per 1,000 resident days (IRR, 1.048; 95% CI, 1.007–1.089). Physician hours required for ASP for the enhanced group totaled 8.9 (±2.2) per facility per month. Conclusions: Although the number of hours required for intervention by an expert was not onerous, maintaining engagement proved difficult and in 2 facilities could not be achieved. A statistically significant 20% decrease in the antibiotic start rate was achieved in the enhanced group after interventions, potentially reflecting the benefit of enhanced ASP support by an expert.Funding: This study was funded by the Leadership in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship training grant award from the CDC.Disclosures: None

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