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Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes

Published online by Cambridge University Press:  21 June 2021

Daniela Uribe-Cano Open the ORCID record for Daniela Uribe-Cano [Opens in a new window] ,
Mozhdeh Bahranian ,
Sally A. Jolles ,
Lindsay N. Taylor ,
Jill J. Miller ,
Sowmya N. Adibhatla  and
Christopher J. Crnich Open the ORCID record for Christopher J. Crnich [Opens in a new window]
Daniela Uribe-Cano
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Mozhdeh Bahranian
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Sally A. Jolles
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Lindsay N. Taylor
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Jill J. Miller
Affiliation:
University of Minnesota Medical School, Minneapolis, Minnesota
Sowmya N. Adibhatla
Affiliation:
Wisconsin Department of Health Services, Madison, Wisconsin
Christopher J. Crnich*
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
*
Author for correspondence: Christopher J. Crnich, E-mail: cjc@medicine.wisc.edu.
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Abstract

Background:

Measuring the appropriateness of antibiotic prescribing in nursing homes remains a challenge. The revised McGeer criteria, which are widely used to conduct infection surveillance in nursing homes, were not designed to assess antibiotic appropriateness. The Loeb criteria were explicitly designed for this purpose but are infrequently used outside investigational studies. The extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes remains insufficiently studied.

Methods:

We conducted a cross-sectional chart review study in 5 Wisconsin nursing homes and applied the revised McGeer and Loeb criteria to all nursing home–initiated antibiotic treatment courses. Kappa (κ) statistics were employed to assess level of agreement overall and by treatment indications.

Results:

Overall, 734 eligible antibiotic courses were initiated in participating nursing homes during the study period. Of 734 antibiotic courses, 372 (51%) satisfied the Loeb criteria, while only 211 (29%) of 734 satisfied the revised McGeer criteria. Only 169 (23%) of 734 antibiotic courses satisfied both criteria, and the overall level of agreement between them was fair (κ = 0.35). When stratified by infection type, levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections (κ = 0.45), fair for skin and soft-tissue infections (0.36), and slight for respiratory tract infections (0.17).

Conclusions:

Agreement between the revised McGeer and Loeb criteria is limited, and nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes. Studies to establish the best method for ongoing monitoring of antibiotic appropriateness in nursing homes are needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 860 - 863
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

The nation’s plan to combat antibiotic resistance. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/us-activities/national-action-plan.html. Published March, 2015. Accessed November 17, 2020.Google Scholar
Mody, L, Crnich, C. Effects of excessive antibiotic use in nursing homes. JAMA Intern Med 2015;175:1339–1341.CrossRefGoogle ScholarPubMed
Morrill, HJ, Caffrey, AR, Jump, RLP, Dosa, D, LaPlante, KL. Antimicrobial stewardship in long-term care facilities: a call to action. J Am Med Dir Assoc 2016;17:183.e1–e16.CrossRefGoogle ScholarPubMed
Crnich, CJ, Jump, R, Trautner, B, Sloane, PD, Mody, L. Optimizing antibiotic stewardship in nursing homes: a narrative review and recommendations for improvement. Drugs Aging 2015;32:699–716.CrossRefGoogle ScholarPubMed
Field, TS, Gurwitz, JH, Avorn, J, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 2001;161:1629–1634.CrossRefGoogle ScholarPubMed
Rotjanapan, P, Dosa, D, Thomas, KS. Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes. Arch Intern Med 2011;171:438–443.10.1001/archinternmed.2011.13CrossRefGoogle ScholarPubMed
Emerson, CB, Eyzaguirre, LM, Albrecht, JS, Comer, AC, Harris, AD, Furuno, JP. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012;33:539–544.CrossRefGoogle ScholarPubMed
Stone, ND, Ashraf, MS, Calder, J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012;33:965–977.CrossRefGoogle ScholarPubMed
van Buul, LW, van der Steen, JT, Veenhuizen, RB, et al. Antibiotic use and resistance in long-term care facilities. J Am Med Dir Assoc 2012;13:568.e1–e13.10.1016/j.jamda.2012.04.004CrossRefGoogle ScholarPubMed
Wang, J, Foxman, B, Mody, L, Snitkin, ES. Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms. Proc Natl Acad Sci 2017;114:10467–10472.CrossRefGoogle ScholarPubMed
Lee, BY, Singh, A, Bartsch, SM, et al. The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2013;34:151–160.CrossRefGoogle ScholarPubMed
Lee, BY, Yilmaz, SL, Wong, KF, et al. Modeling the regional spread and control of vancomycin-resistant enterococci. Am J Infect Control 2013;41:668–673.10.1016/j.ajic.2013.01.013CrossRefGoogle ScholarPubMed
McKinnell, JA, Singh, RD, Miller, LG, et al. The SHIELD Orange County Project: multidrug-resistant organism prevalence in 21 nursing homes and long-term acute care facilities in southern California. Clin Infect Dis 2019;69:1566–1573.CrossRefGoogle ScholarPubMed
Core elements of antibiotic stewardship for nursing homes. Centers for Disease Control and Prevention website. https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html. Published March, 2015. Accessed August 24, 2020.Google Scholar
CMS Requirements of Participation Regulations Vol. 81, No. 192. Federal Register website. https://www.govinfo.gov/content/pkg/FR-2016-10-04/pdf/2016-23503.pdf. Published online October 4, 2016.Accessed May 15, 2021.Google Scholar
Nursing homes. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes. Accessed November 17, 2020.Google Scholar
Shurtleff, S, McGeer, A, McArthur, M, Simor, AE. Antibiotic prescribing patterns in long-term care facilities (LTCFs). Am J Infect Control 1991;19:119.CrossRefGoogle Scholar
Nace, DA, Drinka, PJ, Crnich, CJ. Clinical uncertainties in the approach to long-term care residents with possible urinary tract infection. J Am Med Dir Assoc 2014;15:133–139.CrossRefGoogle ScholarPubMed
Loeb, M, Bentley, DW, Bradley, S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001;22:120–124.10.1086/501875CrossRefGoogle ScholarPubMed
Loeb, M, Simor, AE, Landry, L, et al. Antibiotic use in Ontario facilities that provide chronic care. J Gen Intern Med. 2001;16:376–383.CrossRefGoogle ScholarPubMed
Loeb, M, Brazil, K, Lohfeld, L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ 2005;331(7518):669.10.1136/bmj.38602.586343.55CrossRefGoogle ScholarPubMed
Vergidis, P, Hamer, DH, Meydani, SN, Dallal, GE, Barlam, TF. Patterns of antimicrobial use for respiratory tract infections in older residents of long-term care facilities. J Am Geriatr Soc 2011;59:1093–1098.CrossRefGoogle ScholarPubMed
Zimmerman, S, Sloane, PD, Bertrand, R, et al. Successfully reducing antibiotic prescribing in nursing homes. J Am Geriatr Soc 2014;62:907–912.10.1111/jgs.12784CrossRefGoogle ScholarPubMed
McMaughan, DK, Nwaiwu, O, Zhao, H, et al. Impact of a decision-making aid for suspected urinary tract infections on antibiotic overuse in nursing homes. BMC Geriatr 2016;16:81.10.1186/s12877-016-0255-9CrossRefGoogle ScholarPubMed
Pulia, M, Kern, M, Schwei, RJ, Shah, MN, Sampene, E, Crnich, CJ. Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis. Antimicrob Resist Infect Control 2018;7:74.10.1186/s13756-018-0364-7CrossRefGoogle ScholarPubMed
Olsho, LEW, Bertrand, RM, Edwards, AS, et al. Does adherence to the loeb minimum criteria reduce antibiotic prescribing rates in nursing homes? J Am Med Dir Assoc 2013;14:309.e1–309.e7.CrossRefGoogle Scholar
Eure, T, LaPlace, LL, Melchreit, R, et al. Measuring antibiotic appropriateness for urinary tract infections in nursing home residents. Infect Control Hosp Epidemiol 2017;38:998–1001.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Minor, BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019;95:103208.CrossRefGoogle ScholarPubMed
Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.CrossRefGoogle ScholarPubMed
McElligott, M, Welham, G, Pop-Vicas, A, Taylor, L, Crnich, CJ. Antibiotic stewardship in nursing facilities. Infect Dis Clin North Am 2017;31:619–638.10.1016/j.idc.2017.07.008CrossRefGoogle ScholarPubMed
Phillips, CD, Adepoju, O, Stone, N, et al. Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes. BMC Geriatr 2012;12:73.CrossRefGoogle ScholarPubMed
Kistler, CE. Reply to antibiotic prescribing pathway for urinary tract infections: a “low-hanging fruit” antibiotic stewardship target in nursing homes. J Am Geriatr Soc 2017;65:2745–2746.CrossRefGoogle ScholarPubMed
Loeb, MB, Carusone, SBC, Marrie, TJ, et al. Interobserver reliability of radiologists’ interpretations of mobile chest radiographs for nursing home–acquired pneumonia. J Am Med Dir Assoc 2006;7:416–419.CrossRefGoogle ScholarPubMed
Rowe, TA, Jump, RLP, Andersen, BM, et al. Reliability of nonlocalizing signs and symptoms as indicators of the presence of infection in nursing-home residents. Infect Control Hosp Epidemiol 2020. doi: 10.1017/ice.2020.1282.CrossRefGoogle Scholar
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