Reducing Fluoroquinolone Use and Clostridioides difficile Infections in Community Nursing Homes Through...

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Public Health

Background:

• Nursing homes (NHs) are critical settings for antibiotic stewardship (AS) due to high rates of antibiotic use and Clostridioides difficile infections (CDIs).
• Optimizing antibiotic use in NHs is essential to combat antimicrobial resistance and improve patient outcomes.

Purpose of the Study:

• To describe a collaborative hospital-nursing home model to reduce CDIs through improved antibiotic use, focusing on decreasing high-risk antibiotics like fluoroquinolones.
• To evaluate the impact of this collaborative model on antibiotic consumption and CDI rates in NHs.

Main Methods:

• A quasi-experimental, pre- and post-intervention study involving six NHs in Monroe County, NY.
• Interventions included developing consensus guidelines for common syndromes, staff and resident education, and data sharing, facilitated by a hospital-based AS expert team and a medical director advisory group.
• Poisson and segmented regression analyses were used to assess changes in antibiotic use (days of therapy per 1000 resident days) and CDI rates (per 10,000 resident days).

Main Results:

• Post-intervention, fluoroquinolone use decreased by 39% and total antibiotic use by 9% across all NHs.
• Quarterly CDI rates significantly decreased by 18% following the intervention.
• Interrupted time series analysis confirmed significant reductions in fluoroquinolone and total antibiotic use.

Conclusions:

• A hospital-NH partnership, including a medical director advisory group, effectively reduced fluoroquinolone and total antibiotic use.
• This collaborative approach contributed to a significant reduction in CDI incidence in nursing homes.
• The model provides a framework for NHs to access AS expertise, standardize practices, and improve antimicrobial stewardship within their communities.