Long-Term Care Facilities Cut Superfluous Antibiotic Use

By Jonathan Springston, Editor, Relias Media

Long-term care facilities that followed the recommendations of a federal safety program prescribed fewer antibiotics to residents, thereby preventing needless and dangerous use of these drugs.

Researchers studied the efficacy of the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use in hundreds of long-term care facilities across the United States. Between December 2018 and November 2019, staff at these facilities attended webinars and used many other educational tools that are part of the AHRQ program.

Investigators measured antibiotic starts per 1,000 resident-days, days of antibiotic therapy (DOT) per 1,000 resident-days, number of urine cultures per 1,000 resident-days, and Clostridioides difficile laboratory-identified events per 10,000 resident-days. The authors gathered baseline data (January 2019 to February 2019) and compared that information to data accumulated after staff had a chance to participate in and digest the AHRQ safety program (November 2019 to December 2019).

In facilities that completed the program, the authors noted a mean reduction in antibiotic starts by 0.41 per 1,000 resident days. Fluoroquinolones, an especially risky class of antibiotic, represented the greatest decline, at -0.21 starts per 1,000 resident-days. The researchers also observed reductions in oral antibiotic use (these are used more often than intravenous antibiotics) and in urine culture orders (these can produce unclear or unreliable results regarding infections in elderly patients).

The authors noted how more than 70% of long-term care residents might receive at least one course of antibiotics every year, yet as many as 75% of those prescriptions could be inappropriate or out of alignment with guidelines. Concurrently, they noted high staff turnover and challenging diagnostics as hurdles to implementing effective training in this area.

“Despite these challenges, the AHRQ Safety Program used patient-safety principles, multidisciplinary education, and a multitude of interactive tools aimed at incorporating stewardship principles into daily practice; high participation in the program was associated with a reduction in antibiotic use and improved outcomes,” the authors concluded. “Data are needed to evaluate the sustainability of these interventions and their long-term effect on antibiotic use, resident outcomes, and staff and resident satisfaction.”

For more on this and related subjects, be sure to read the latest issues of Hospital Infection Control & Prevention and Infectious Disease Alert.