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Trends in antibiotics use among long-term US nursing-home residents

Published online by Cambridge University Press:  16 September 2020

Catherine C. Cohen ,
Andrew W. Dick ,
Mansi Agarwal Open the ORCID record for Mansi Agarwal [Opens in a new window] ,
Tadeja Gracner ,
Susan Mitchell  and
Patricia W. Stone
Catherine C. Cohen*
Affiliation:
Behavioral & Policy Sciences, RAND Corporation, Santa Monica, California
Andrew W. Dick
Affiliation:
Economics, Sociology & Statistics, RAND Corporation, Boston, Massachusetts
Mansi Agarwal*
Affiliation:
Center for Health Policy, Columbia University School of Nursing, New York, New York
Tadeja Gracner
Affiliation:
Economics, Sociology & Statistics, RAND Corporation, Washington, DC
Susan Mitchell
Affiliation:
Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts
Patricia W. Stone
Affiliation:
Center for Health Policy, Columbia University School of Nursing, New York, New York
*
Authors for correspondence: Catherine C. Cohen, E-mail: ccohen@rand.org. Or Mansi Agarwal, E-mail: ma3204@cumc.columbia.edu.
Authors for correspondence: Catherine C. Cohen, E-mail: ccohen@rand.org. Or Mansi Agarwal, E-mail: ma3204@cumc.columbia.edu.
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Abstract

Objectives:

Antibiotics are overly prescribed in nursing homes. Recent antibiotic stewardship efforts attempt to reduce inappropriate use. Our objective was to describe antibiotic use from 2012 to 2016 among nursing-home residents with various health conditions.

Design:

Retrospective, repeated cross-sectional analysis.

Setting and participants:

All long-term residents in a random 10% sample of national nursing homes: 2,092,809 assessments from 319,615 nursing-home residents in 1,562 nursing homes.

Measurements:

We calculated a 1-day antibiotic prevalence using all annual and quarterly clinical assessments in the Minimum Data Set (MDS) from April 2012 through December 2016. We calculated prevalence of antibiotic use overall and within conditions of interest: Alzheimer’s disease and related dementias (ADRD), advanced cognitive impairment (ACI), and infections likely to be treated with antibiotics. We applied logistic regressions with nursing-home cluster, robust standard errors to assess changes in conditions and antibiotic use 2012–2016.

Results:

Overall, antibiotic use did not change (2012 vs 2016, adjusted odds ratio [AOR], 1.00; 95% CI, 0.97–1.03). Antibiotic use was higher in 2016 versus 2012 among assessments with any infection (AOR, 1.10; 95% CI, 1.04–1.16), urinary tract infection (AOR, 1.18; 95% CI, 1.12–1.25), and no infection (AOR, 1.13; 95% CI, 1.09–1.17). Results were similar by cognitive status.

Conclusions:

The increased proportion of assessments recording antibiotics but no infection may not be clinically appropriate. Higher antibiotic use among infected residents with advanced cognitive impairment is also concerning. Further efforts to understand mechanisms driving these trends and to promote antibiotic stewardship in nursing homes are warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 3 , March 2021 , pp. 311 - 317
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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