Abstract
Objectives
Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship
programs is a national priority. Our aim is to evaluate the influence of antibiotic
stewardship programs on antibiotic use rates in NHs over time.
Design
Retrospective, repeated cross-sectional analysis.
Setting and Participants
Long-term residents not receiving hospice care in freestanding NHs that participated
in 1 or both surveys in 2013 and 2017.
Methods
Survey data were merged with the Minimum Data Set and the Certification and Survey
Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic
use. The main predictor was the NH antibiotic stewardship policy intensity. Using
multivariate linear regression models adjusting for resident and facility characteristics
that differed between the 2 years, we calculated antibiotic use rates in 2013 and
2017 for all residents, those with Alzheimer's disease, and those with any infection
including urinary tract infections (UTIs).
Results
Our sample included 317,003 resident assessments from 2013 and 267,537 assessments
from 2017, residing in 953 and 872 NHs, respectively. NH antibiotic stewardship policy
intensity increased from 2013 to 2017 (P < .01) and among all NH residents, including those with Alzheimer's disease, antibiotic
use rate decreased (P < .05), with 45% of the decline attributable to strengthening stewardship programs.
For most residents, policy intensity was associated with decreased usage in residents
with UTI. However, among Alzheimer's disease residents with a UTI, this association
did not persist.
Conclusions and Implications
Although there was a decrease in antibiotic use in 2017, more time is needed to see
the full impact of antibiotic stewardship policy into practice. Adjustments to programs
that directly address barriers to implementation and appropriate UTI antibiotic use
for residents with Alzheimer's disease are necessary to continue strengthening NH
antibiotic stewardship and improve care.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Infection trends in US nursing homes, 2006-2013.J Am Med Dir Assoc. 2017; 18 (635.e639-635.e620)
- Trends in antibiotics use among long-term US nursing-home residents.Infect Control Hosp Epidemiol. 2021; 42: 311-317
- Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia.JAMA Intern Med. 2014; 174: 1660-1667
- Urinary tract infection and asymptomatic bacteriuria in older adults.Infect Dis Clin North Am. 2017; 31: 673-688
- Policy statement on antimicrobial stewardship by the society for Healthcare Epidemiology of America (SHEA), the infectious diseases society of America (IDSA), and the pediatric infectious diseases society (PIDS).Infect Control Hosp Epidemiol. 2012; 33: 322-327
- Nursing home infection control program characteristics, CMS citations, and implementation of antibiotic stewardship policies: A national study.Inquiry. 2018; 55 (46958018778636)
- Changes in US nursing home infection prevention and control programs from 2014 to 2018.J Am Med Dir Assoc. 2020; 21: 97-103
- Infection prevention and control programs in US nursing homes: Results of a national survey.J Am Med Dir Assoc. 2016; 17: 85-88
- Integration of palliative care and infection management at the end of life in U.S. nursing homes.J Pain Symptom Manage. 2019; 58: 408-416.e401
- QIO Program: Quality Innovation Network - Quality Improvement Organizations, Better Health, Better Care, Lower Cost.Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Baltimore, MD2014
Centers for Disease Control and Prevention. National Healthcare safety Network (NHSN). Available at: https://www.cdc.gov/nhsn/index.html. Accessed January 26, 2021.
- Making the investment count: Revision of the Minimum data set for nursing homes, MDS 3.0.J Am Med Dir Assoc. 2012; 13: 602-610
- Hospice care.(Available at:)https://www.medicare.gov/coverage/hospice-careDate accessed: May 27, 2021
- N0410F medications received: Antibiotic number days.(Available at:)https://resdac.org/cms-data/variables/n0410f-medications-received-antibiotic-number-daysDate: 2012Date accessed: May 27, 2021
- The Core Elements of Antibiotic Stewardship for Nursing Homes.The National Center for Emerging and Zoonotic Infectious Diseases within the Centers for Disease Control and Prevention, Atlanta, GA2015
- Five-star quality rating system.(Available at:)https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRSDate accessed: January 26, 2021
- Approved: New antimicrobial stewardship standard.Jt Comm Perspect. 2016; 36: 3-4
- Implementing an antibiotic stewardship program: Guidelines by the infectious diseases society of America and the society for Healthcare Epidemiology of America.Clin Infect Dis. 2016; 62: e51-e77
- Home antimicrobial stewardship guide.(Available at:)
- Promoting wise antibiotic use in nursing homes.(Available at:)https://nursinghomeinfections.unc.edu/Date accessed: February 5, 2021
- There is no one to pick up the pieces": Sustainability of antibiotic stewardship programs in nursing homes.Infect Control Hosp Epidemiol. 2021; 42: 440-447
- Characteristics of nursing homes with comprehensive antibiotic stewardship programs: Results of a national survey.Am J Infect Control. 2020; 48: 13-18
- Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention.Am J Infect Control. 2008; 36: 476-480
- COVID-19 preparedness in nursing homes in the midst of the pandemic.J Am Geriatr Soc. 2020; 68: 1164-1166
- Initial and repeated point prevalence surveys to inform SARS-CoV-2 infection prevention in 26 skilled nursing facilities – detroit, Michigan, march-may 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 882-886
- Antibiotic use in the United States, 2020 update: Progress and opportunities.(Available at:)https://www.cdc.gov/antibiotic-use/stewardship-report/current.htmlDate: 2020Date accessed: February 5, 2021
- FastStats: Alzheimer's disease.(Available at:)
- Toolkit 1.Suspected UTI SBAR Toolkit, 2016 (Available at:)https://www.ahrq.gov/nhguide/toolkits/determine-whether-to-treat/toolkit1-suspected-uti-sbar.htmlDate accessed: May 27, 2021
- Factors associated with antimicrobial use in nursing home residents with advanced dementia.J Am Med Dir Assoc. 2021; 22: 178-181
Article info
Publication history
Published online: July 20, 2021
Footnotes
This work was supported by the National Institute of Nursing Research of the National Institutes of Health (Grant number: R01 NR013687; Grant number: T32 NR014205). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
