152. Oral Antibiotic Utilization in Long Term Care:  Are We Following Guidelines or Chasing Resistance?
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • 152_IDWPOSTER_DPATRICK.pdf (464.8 kB)
  • Background: The long-term care facility (LTCF) setting may act as a reservoir for antibiotic resistance in the community and hospitals. In British Columbia (BC), the rise in resistance to fluoroquinolones and cotrimoxazole in Enterobacteriaceae has been most pronounced in the elderly. This study represents the first population-based description of antibiotic utilization trends associated with these resistance patterns in LTCFs in BC.

    Methods: BC PharmaNet is a database that captures all outpatient and LTCF prescriptions in BC. Anonymized, line-listed data were accessed for oral systemic antibiotics covered under Plan B (permanent residents of licensed LTCFs). Utilization rates (Daily Defined Doses (DDD)/1000 LTCF residents/day) between 2007-2013 were analyzed, with a focus on drugs used for urinary tract infections (UTI), including: nitrofurantoin, ciprofloxacin, cotrimoxazole, amoxicillin-clavulanate, and cefixime.

    Results: There were 357,150 LTCF antibiotic prescriptions (1.9% of all PharmaNet) written between 2007 and 2013. 73.3% were for females and 93.0% were for those aged over 65 years. Overall utilization increased 3.6% from 152.1 in 2007 to 157.6 DDD/1000 LTCF residents/day in 2013. 51% of utilization was for the 5 above-listed agents.  The table illustrates the change in use for these drugs. 

    Antibiotic

    Utilization in 2007

    (DDD/1000 LTCF residents/day)

    Utilization in 2013

    (DDD/1000 LTCF residents/day)

    Absolute Change (DDD/1000 LTCF residents/day)

    Relative Change (%)

    Nitrofurantoin*

    35.5

    35.8

    +0.3

    +0.8%

    Ciprofloxacin

    21.6

    18.2

    -3.4

    -15.7%

    Cotrimoxazole

    19.1

    16.7

    -2.4

    -12.6%

    Amoxicillin-clavulanate

    2.7

    7.5

    +4.8

    +177.8%

    Cefixime

    1.0

    3.7

    +2.7

    270.0%

    * Nitrofurantoin use increased from 35.5 in 2007 to 38.8 DDD/1000 LTCF residents/day in 2012 (9.3%), then decreased as above.

    Conclusion: While an increase in nitrofurantoin use might be congruent with guidelines, greater use of cefixime and amoxicillin-clavulanate, in the absence of changing trends in respiratory infections, suggest that prescribing may be driven by an increasing prevalence of enterobacteriacae with ESBLs. Stewardship efforts focused on reducing unnecessary cultures and treatment of asymptomatic bacteriuria are urgently needed in BC LTCFs.

    David Patrick, MD, MHSc1, Christopher Mill, MPH2, Diana George, MSc3, Mei Chong, MSc3 and Fawziah Marra, PharmD4, (1)School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, (2)School of Population and Public Health, University of British Columbia, Vancovuer, BC, Canada, (3)British Columbia Centre for Disease Control, Vancouver, BC, Canada, (4)Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    Disclosures:

    D. Patrick, None

    C. Mill, None

    D. George, None

    M. Chong, None

    F. Marra, Merck Canada Inc: Grant Investigator , Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.