Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes.
Aged
Anti-Bacterial Agents
/ classification
Antimicrobial Stewardship
/ methods
Drug Administration Routes
Drug Utilization Review
/ methods
Duration of Therapy
Female
Humans
Long-Term Care
/ methods
Male
Medicare
/ statistics & numerical data
Nursing Homes
/ statistics & numerical data
Practice Patterns, Physicians'
/ statistics & numerical data
Skilled Nursing Facilities
/ statistics & numerical data
United States
/ epidemiology
antibiotic stewardship
fluoroquinolone
post-acute and long-term care
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
16
06
2020
revised:
31
08
2020
accepted:
10
09
2020
pubmed:
11
10
2020
medline:
18
9
2021
entrez:
10
10
2020
Statut:
ppublish
Résumé
Data describing antibiotic use in U.S. nursing homes remain limited. We report antibiotic use among skilled nursing facility residents from 29 U.S. nursing homes and assessed correlations between antibiotics prescribed to residents in skilled care and nursing home characteristics. Retrospective cohort study. Twenty-nine U.S. nursing homes in the same healthcare corporation. Residents receiving skilled care in 2016. We used pharmacy invoice and nursing home census data to calculate the days of antibiotic therapy per 1,000 days of skilled care (1,000 DOSC), the rate of antibiotic starts per 1,000 DOSC, the length of antibiotic therapy, and the average antibiotic spectrum index. We also assessed correlations between antibiotic use and nursing home characteristics. Antibiotics accounted for an average of 9.6% (±0.6%) of systemic medications prescribed among residents receiving skilled care. On average, 26.8% (±2.9%) of antibiotics were intravenous. Fluoroquinolones were prescribed at the highest rates (19% across all facilities), followed by beta-lactam/beta-lactamase inhibitors (11%), first- and second-generation cephalosporins, sulfonamides, and oral tetracyclines (each at 9%). Both the proportion of residents using enrolled in Medicare and number of unique prescribers responsible for systemic prescriptions positively correlated with the rate of antibiotic starts. Our study demonstrates that pharmacy invoices represent a useful and preexisting source of data for assessing antibiotic prescriptions among individuals receiving skilled nursing care. The correlation between the number of unique prescribers and antibiotic starts suggests that prescribers are central to efforts to improve antibiotic use in nursing homes.
Sections du résumé
BACKGROUND
Data describing antibiotic use in U.S. nursing homes remain limited. We report antibiotic use among skilled nursing facility residents from 29 U.S. nursing homes and assessed correlations between antibiotics prescribed to residents in skilled care and nursing home characteristics.
DESIGN
Retrospective cohort study.
SETTING
Twenty-nine U.S. nursing homes in the same healthcare corporation.
PARTICIPANTS
Residents receiving skilled care in 2016.
MEASUREMENTS
We used pharmacy invoice and nursing home census data to calculate the days of antibiotic therapy per 1,000 days of skilled care (1,000 DOSC), the rate of antibiotic starts per 1,000 DOSC, the length of antibiotic therapy, and the average antibiotic spectrum index. We also assessed correlations between antibiotic use and nursing home characteristics.
RESULTS
Antibiotics accounted for an average of 9.6% (±0.6%) of systemic medications prescribed among residents receiving skilled care. On average, 26.8% (±2.9%) of antibiotics were intravenous. Fluoroquinolones were prescribed at the highest rates (19% across all facilities), followed by beta-lactam/beta-lactamase inhibitors (11%), first- and second-generation cephalosporins, sulfonamides, and oral tetracyclines (each at 9%). Both the proportion of residents using enrolled in Medicare and number of unique prescribers responsible for systemic prescriptions positively correlated with the rate of antibiotic starts.
CONCLUSIONS
Our study demonstrates that pharmacy invoices represent a useful and preexisting source of data for assessing antibiotic prescriptions among individuals receiving skilled nursing care. The correlation between the number of unique prescribers and antibiotic starts suggests that prescribers are central to efforts to improve antibiotic use in nursing homes.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
399-406Informations de copyright
© 2020 The American Geriatrics Society.
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