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Factors associated with antimicrobial use in nursing homes: a multilevel model
Stephen R Benoit1, Wato Nsa, Chesley L Richards
1Division of Healthcare Quality Promotion, Centers for Disease Control and Preventation, Atlanta, Georgia, USA. SBenoit@cdc.gov
Journal of the American Geriatrics Society
|November 20, 2008
Summary
Antimicrobial prescribing in nursing homes is highly variable, with respiratory and urinary tract infections being the most common reasons for antibiotic use. Interventions targeting specific diagnoses may help optimize antibiotic use in this setting.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Pharmacology
Background:
- Nursing home residents represent a vulnerable population with unique healthcare needs.
- Antimicrobial stewardship is crucial in long-term care facilities to combat resistance.
- Understanding current prescribing patterns is essential for developing effective interventions.
Purpose of the Study:
- To characterize antimicrobial prescribing patterns within nursing homes.
- To identify factors associated with antimicrobial use in this setting.
Main Methods:
- A retrospective, observational study was conducted across 73 nursing homes in four U.S. states.
- Data were collected from September 1, 2001, to February 28, 2002, involving 4,780 residents.
- Prescribing patterns, indications, and associated resident/facility factors were analyzed.
Main Results:
- Over 42% of residents received at least one antibiotic course.
- Mean usage was 4.8 courses per 1,000 resident-days, with significant facility-level variation.
- Fluoroquinolones, first-generation cephalosporins, and macrolides were the most common drug classes.
- Respiratory and urinary tract infections were the primary indications for antimicrobial prescriptions.
Conclusions:
- Significant variability exists in antimicrobial prescribing within nursing homes.
- Higher rates of antimicrobial use were associated with factors like nursing home discharge probability and specific Resource Utilization Groups.
- Targeted educational interventions focusing on common diagnoses may optimize antimicrobial use.
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