Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility. Issue 1 (29th August 2019)

• Record Type: Journal Article
• Authors: Davenport, Claire; Brodeur, Michael; Wolff, Michael; Meek, Patrick D.; Crnich, Christopher J.
• Is Part Of: Journal of the American Geriatrics Society. Volume 68:Issue 1(2020)
• Page Start: 55
• Page End: 61
• Publication Date: 2019-08-29
• Subjects: antibiotic stewardship -- skilled nursing facility -- sepsis; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.16134
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract : OBJECTIVES: To derive weighted‐incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use. DESIGN: Retrospective analysis of microbial data from a regional laboratory. SETTING: We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015. PARTICIPANTS: A total of 28 regional SNFs (rSNFs) and 7 in‐network SNFs (iSNFs). MEASUREMENTS: WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole. RESULTS: Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11‐113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76‐11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I 2 = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols. CONCLUSION: These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55–61, 2019 Abstract : See related editorial by Furuno et al . in this issue.