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Systemic antibiotic use in nursing homes. A quality assessment
Journal of the American Geriatrics Society
|October 1, 1986
Summary
Systemic antibiotic use in nursing homes is common, with 7.7% of patients on antibiotics. Diagnostic workups for infections were often inadequate, highlighting a need for improved antibiotic stewardship in these facilities.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Pharmacology
Background:
- Systemic antibiotic use is prevalent in skilled nursing facilities (SNFs) and intermediate care facilities (ICFs).
- Assessing the quality of antibiotic prescribing and diagnostic workups is crucial for patient safety and combating antimicrobial resistance.
Purpose of the Study:
- To evaluate the prevalence and quality of systemic antibiotic use in nursing homes.
- To assess the appropriateness of antibiotic initiation and diagnostic workups for common infections in this setting.
Main Methods:
- Survey of 42 SNFs and 11 ICFs, with a random sample of 2238 patients.
- Development of criteria for antibiotic appropriateness, diagnostic adequacy, and specific antibiotic selection based on CDC and FDA guidelines.
- Evaluation of antibiotic use and diagnostic practices for suspected infections.
Main Results:
- 7.7% of surveyed patients were on systemic antibiotics (8.6% in SNFs, 4.5% in ICFs).
- Antibiotic initiation evidence was adequate in 62.4% of cases.
- Diagnostic workups were frequently inadequate, e.g., urinalysis in 23.8% and urine culture in 57.4% for suspected UTIs; chest x-ray in 24.2% and sputum culture in 3.0% for suspected LRIs.
Conclusions:
- Significant opportunities exist to improve antibiotic stewardship in nursing homes.
- Recommendations focus on minimum adequate diagnostic workups and evidence required to justify antibiotic initiation, considering the unique challenges of the nursing home environment.