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>

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

2012 ◽  
Vol 33 (12) ◽  
pp. 1185-1192 ◽  
Author(s):  
Robin L. P. Jump ◽  
Danielle M. Olds ◽  
Nasim Seifi ◽  
Georgios Kypriotakis ◽  
Lucy A. Jury ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Care Facility ◽  
Antimicrobial Use ◽  
Consultation Service ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

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.

scholarly journals 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S845-S846
Author(s):  
Bridget A Olson ◽  
Michael L Butera ◽  
Noam Ship
Keyword(s):  
Infection Prevention ◽  
Long Term Care ◽  
Care Facility ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Prevention Strategies ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Abstract Background Long-term care patients are at high risk of C. difficile infections (CDI) due to advanced age, high comorbid illness burden, and frequent antibiotic use. Primary infection prevention of CDI is challenging and not frequently studied. Following a period of high CDI incidence, the Long-Term Care facility at Sharp Coronado Hospital implemented a bundle of strategies. Methods Patient census, the incidence of CDI (primary and recurrent cases), transfers to acute care and length-of-stay were collected from Jul 2008 through December 2018. In the first phase, 2010, a bundle of CDI prevention strategies was initiated, including an Antimicrobial Stewardship Program (ASP), reduction of acid suppression, and L. acidophilus and S. boulardii probiotics with antibiotic use. From 2012, there was further refinement of the ASP and the probiotic was changed to capsules of a 3-species combination of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2, 100 Billion CFU daily. In October 2016, a protocol was put in place delegating authority to pharmacists to add probiotics to all antibiotic courses. The average CDI rates were calculated and compared for each time period. The net cost of CDI was calculated from the number of CDI cases, hospital length-of-stay and probiotic purchases. Results The incidence of facility-onset CDI cases decreased significantly with each policy change from 7.6 cases/10,000 patient-days (2008–09), to 2.8 (2010–11, p = 0.028), to 0.91 (2012-Q3 2016, p = 0.0015) and to the present incidence 0.24 (Q4 2016–2018, p = 0.048). The annual cost of facility-onset CDI was $214k initially. The annual cost, including the purchase of probiotic, decreased to $161k with introduction of the bundle, to $57k in switching probiotics, and to $18k with initiation of a probiotic policy. Conclusion Implementing a bundle of concurrent infection prevention strategies resulted in a significant reduction in CDI incidence. Refinements to the bundle led to significant reductions in CDI incidence, along with switching the type of probiotic, and delegating ordering authority to pharmacists to ensure probiotic compliance. Cumulatively, there was a 95% decrease in CDI incidence at the Long-Term Care facility and meaningful cost savings with each refinement. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of Urinary Tract Infection Testing and Treatment to Guide Antimicrobial Stewardship in the Long-Term Care Facility

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Cathleen Concannon ◽  
Gail Quinlan ◽  
Christina Felsen ◽  
Elizabeth Dodds Ashley ◽  
Kavita K. Trivedi ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

A comparison of Energy Provision by Diet Order in a Long-Term Care Facility

2008 ◽  
Vol 27 (2) ◽  
pp. 225-227 ◽  
Author(s):  
Matthew Durant
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Personnes Âgées ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Perte De Poids ◽  
Longue Duree ◽  
Pour Cent

RÉSUMÉLa perte de poids involontaire est courante chez les personnes âgées en Amérique du Nord et touche jusqu’à 60 pour cent des résidents des centres d’accueil, ce qui représente une menace pour la santé et l'équilibre fonctionnel. Une enquête portant sur la fourniture d’éléments nutritifs dans un centre de soins de longue durée (SLD) a indiqué que l'exposition moyenne à l'énergie totale au cours d’un cycle de menus couvrant cinq semaines présentait une différence importante entre le régime régulier et le régime d’aliments en purées, et que le niveau moyen d’exposition aux trois macronutriments était inférieur dans un régime d’aliments en purée. Ce qui prouve que les menus actuels des SLD fournissent moins d’aliments nutritifs à ceux qui reçoivent des d’aliments en purée et qu’il faudrait une enquête plus poussée dans ce domaine.

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