Evaluating Antibiotic Use in a Veterans Affairs Skilled Nursing Facility

Objective To examine antibiotic use in long-term care residents at a VA skilled nursing facility. Design Quality improvement project. Setting Long-term care residents admitted to the Community Living Center of a Midwestern VA medical center. Patients Inclusion criteria were long-term care residents admitted to the VA skilled nursing facility who were prescribed an oral (including via percutaneous endoscopic gastrostomy tube) antibiotic from January 1, 2018, to December 31, 2018. Residents were excluded if they were admitted for hospice care, rehabilitation, or short-term skilled nursing. Residents were also excluded if they were on intravenous or topical antibiotics. Results Fifty-six unique antibiotic courses consisting of 13 different antibiotics were evaluated. Median days of therapy per 1,000 resident days was 39.7 overall, for quarter 1 was 51, quarter 2 was 42, quarter 3 was 49.3, and quarter 4 was 17.5. Average antibiotic days of therapy was 7.6 days. Fluoroquinolones comprised 26.8% of the courses, followed by beta-lactamase inhibitors at 25%. Of the 56 courses, 85.7% were found to have appropriate dose/frequency, while 73.2% had appropriate duration. No reports of Clostridioides difficile infection were noted. Thirty-one antibiotic courses had cultures obtained, of which 29 did not deescalate therapy. Of these, 5 (17.2%) were indicated for de-escalation. Conclusion Antibiotic use in this skilled nursing facility have opportunities for intervention, including reducing fluoroquinolone use, optimizing de-escalation, and shortening days of therapy. The implementation of an antimicrobial stewardship monitoring program within the long-term care setting could assist in maximizing therapy while reducing antibiotic exposure.