Consideration for the appropriate use of antimicrobials in long-term care wards

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Healthcare Management

Background:

• Long-term care wards house patients with complex needs, including advanced neuromuscular disorders and severe disabilities.
• Appropriate antimicrobial use in these settings is understudied.
• This study addresses the need to define clinical conditions necessitating antibiotic therapy in long-term care.

Purpose of the Study:

• To identify and confirm clinical conditions that warrant antibiotic treatment in long-term care facilities.
• To evaluate the impact of antimicrobial stewardship principles on antibiotic prescribing patterns.

Main Methods:

• Retrospective review of electronic medical records for patients receiving intravenous infusions from January 2018 to December 2020.
• Comparison of antibiotic treatment between a 'usual treatment' group and an 'optimal treatment' group implementing antimicrobial stewardship.
• Analysis of patient demographics, diagnoses, and C-reactive protein (CRP) levels.

Main Results:

• Antibiotic therapy was administered in 37.2% of infusions in the usual treatment group versus 23.3% in the optimal treatment group (P=0.04).
• A significant difference was noted in the diagnosis of aspiration or respiratory tract infections (P<0.01).
• Peak C-reactive protein (CRP) levels during an event emerged as a key indicator for antibiotic necessity.

Conclusions:

• Comprehensive assessment of patient condition and CRP levels is vital for judicious antibiotic use.
• Implementing antimicrobial stewardship principles can reduce inappropriate antibiotic prescriptions in long-term care.
• Further research can refine guidelines for antibiotic use in vulnerable long-term care populations.