Using antibiograms to improve antibiotic prescribing in skilled nursing facilities

Area of Science:

• Infectious Diseases
• Geriatric Medicine
• Health Services Research

Background:

• Antibiotic prescribing guidelines are established for acute-care settings.
• The efficacy of antibiograms in skilled nursing facilities (SNFs) remains uninvestigated.

Purpose of the Study:

• To create SNF-specific antibiograms.
• To identify strategies for enhancing antibiotic prescribing practices within SNFs.

Main Methods:

• A cross-sectional and pretest-posttest design was employed across three Maryland SNFs.
• SNF clinical culture data and acute care transfer data were used to generate antibiograms via WHONET software.
• A pretest-posttest intervention assessed the impact of antibiogram implementation on antibiotic prescribing in one SNF.

Main Results:

• Analysis of 839 charts revealed 85% of initial antibiotic use in SNFs was empirical.
• Fluoroquinolones were the most common empirical antibiotic (54.5%).
• Appropriate empirical antibiotic prescribing was observed in only 35% of cases with available culture data; this increased from 32% to 45% post-antibiogram implementation, though not significantly.

Conclusions:

• Antibiogram implementation shows potential for improving empirical antibiotic prescribing in SNFs.
• Further investigation is warranted to establish the statistical significance and clinical impact of antibiograms in SNF settings.