Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-14T04:23:52.429Z Has data issue: false hasContentIssue false
  • English
  • Français

Effective Antimicrobial Stewardship in a Long-Term Care Facility through an Infectious Disease Consultation Service: Keeping a LID on Antibiotic Use

Published online by Cambridge University Press:  02 January 2015

Robin L. P. Jump ,
Danielle M. Olds ,
Nasim Seifi ,
Georgios Kypriotakis ,
Lucy A. Jury ,
Emily P. Peron ,
Amy A. Hirsch ,
Paul E. Drawz ,
Brook Watts  and
Robert A. Bonomo
...Show all authors
Robin L. P. Jump*
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Danielle M. Olds
Affiliation:
National Quality Scholars Program, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Nasim Seifi
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Georgios Kypriotakis
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Lucy A. Jury
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Emily P. Peron
Affiliation:
Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
Amy A. Hirsch
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Pharmacy Services, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Paul E. Drawz
Affiliation:
Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Brook Watts
Affiliation:
Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Departments of Pathology, Pharmacology, and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Curtis J. Donskey
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
*
GRECC 111C(W), Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106 (robinjump@gmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Design.

We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.

Setting.

A 160-bed VA LTCF.

Methods.

Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.

Results.

Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P = .008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P = .04).

Conclusions.

Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 12 , December 2012 , pp. 1185 - 1192
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jones, AL, Dwyer, LL, Bercovitz, AR, Strahan, GW. The National Nursing Home Survey: 2004 overview. Vital Health Stat 2009;167:1–155.Google Scholar
2.National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD: National Center for Health Statistics, 2011.Google Scholar
3. US Census Bureau Public Information Office. An older and more diverse nation by midcentury. Release CB08-123, http://www.census.gov/newsroom/releases/archives/population/cb08-123.html. Published August 14, 2008. Accessed March 7, 2012.Google Scholar
4.Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21(10):674–679.Google Scholar
5.Strausbaugh, LJ. Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 2001;7(2):268–271.Google Scholar
6.Juthani-Mehta, M, Quagliarello, VJ. Infectious diseases in the nursing home setting: challenges and opportunities for clinical investigation. Clin Infect Dis 2010;51(8):931–936.Google Scholar
7.Trick, WE, Weinstein, RA, DeMarais, PL, et al.Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 2001;49(3):270–276.Google Scholar
8.Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RLP, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45(8):992–998.Google Scholar
9.Nicolle, LE, Bendey, DW, Garibaldi, R, Neuhaus, EG, Smith, PW. Antimicrobial use in long-term–care facilities. Infect Control Hosp Epidemiol 2000;21(8):537–545.Google Scholar
10.Peron, EP, Hirsch, AA, Jump, RLP, Donskey, CJ. Don't let the steward sail without us: high rate of unnecessary antimicrobial use in long-term care facility. Paper presented at: 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 12–15, 2010; Boston, MA.Google Scholar
11.Cohen, SH, Gerding, DN, Johnson, S, et al.Clinical practice guide-lines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31(5):431–455.Google Scholar
12.Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile–associated disease. Emerg Infect Dis 2006;12(10):1576–1579.Google Scholar
13.Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27(4):299–309.Google Scholar
14.Judge, GG, Griffiths, WE, Hill, RC, Lee, TC. The Theory and Practice of Econometrics. New York: Wiley, 1980.Google Scholar
15.Jump, RLP, Riggs, MM, Sethi, AK, et al.Multihospital outbreak of Clostridium difficile infection, Cleveland, Ohio, USA. Emerg Infect Dis 2010;16(5):827–829, http://wwwnc.cdc.gov/eid/article/16/5/07-1606_article.htm.Google Scholar
16.Jury, LA, Jump, RLP, Sitzlar, B, Guerrero, DM, Donskey, CJ. Improved diagnosis and treatment of Clostridium difficile infection in a long-term care facility after initiation of an on-site infectious disease consultation service. Paper presented at: 21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (SHEA); April 2, 2011; Dallas, TX. Abstract 90.Google Scholar
17.Schwartz, DN, Abiad, H, DeMarais, PL, et al.An educational intervention to improve antimicrobial use in a hospital-based long-term care facility. J Am Geriatr Soc 2007;55(8):1236–1242.Google Scholar
18.Monette, J, Miller, MA, Monette, M, et al.Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities. J Am Geriatr Soc 2007;55(8):1231–1235.Google Scholar
19.Loeb, M. 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):669–670.Google Scholar
20.Zabarsky, TF, Sethi, AK, Donskey, CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control 2008;36(7):476–480.Google Scholar
21.Benoit, SR, Nsa, W, Richards, CL, et al.Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc 2008;56(11):2039–2044.Google Scholar
22.Mylotte, JM. Measuring antibiotic use in a long-term care facility. Am J Infect Control 1996;24(3):174–179.Google Scholar
23.Johnson, S, Samore, MH, Farrow, KA, et al.Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999;341(22):1645–1651.Google Scholar
24.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353(23):2442–2449.Google Scholar
25.Polk, RE, Hohmann, SF, Medvedev, S, Ibrahim, O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53(11):1100–1110.Google Scholar
26.Caprio, TV, Karuza, J, Katz, PR. Profile of physicians in the nursing home: time perception and barriers to optimal medical practice. J Am Med Dir Assoc 2009;10(2):93–97.Google Scholar
27.Dellit, TH, Owens, RC, McGowan, JE, et al.Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44(2):159–177.Google Scholar
28.VanSchooneveld, TV, Miller, H, Sayles, H, Watkins, K, Smith, PW. Survey of antimicrobial stewardship practices in Nebraska long-term care facilities. Infect Control Hosp Epidemiol 2011;32(7):732–734.Google Scholar
29.Smith, PW, Bennett, G, Bradley, S, et al.SHEA/APIC guideline: infection prevention and control in the long-term care facility. Am J Infect Control 2008;36(7):504–535.Google Scholar
30.Smith, PW, Watkins, K, Miller, H, VanSchooneveld, T. Antibiotic stewardship programs in long-term care facilities. Ann Long-Term Care Clin Care Aging 2011;19(4):20–25.Google Scholar