Background: Measuring antimicrobial use (AU) is an important component of designing and monitoring antimicrobial stewardship activities. As stewardship expands to include long-term care facilities (LTCFs), AU data presents many challenges. As part of a city-wide initiative to curb Clostridium difficile infection (CDI), LTCF AU was obtained from purchasing and dispensing data at a cohort of 3 facilities to determine best metrics for guiding interventions.
Methods: Antimicrobial purchasing and patient-level dispensing data were obtained from each facility beginning in July 2013 in collaboration with the facility pharmacist. These data were then compiled and used to generate AU rates: defined daily doses (DDD) were calculated from purchasing data; days of therapy (DOT) normalized to 1,000 patient-days were calculated from dispensing data. Antimicrobial use was further delineated by indication when available.
Results: Data were obtained from 3 LTCFs in Monroe County, NY. One was university-affiliated and they ranged between 340 and 575 beds. Initial comparison of DOT and DDD data from one facility (Fig 1) quickly identified significant discrepancies between the two metrics illustrating the inaccuracy of using DDD data, where spikes occur due to intermittent bulk purchasing practices. Therefore, DOT data was identified as the standard metric. Comparing data across the 3 LTCFs showed variation in AU which ranged from 25 - 100 DOTs/1000 patient-days (Fig 2). Urinary tract infection was the most common indication for antimicrobial use (502/1,609 courses, 31%), followed by skin and soft tissue infection (233/1,609 courses, 14%).
Conclusion: Antimicrobial use for LTCFs is best reflected using DOTs to provide a more accurate measure in a vulnerable population where doses are commonly adjusted for comorbidities such as renal impairment. DOT data allow LTCFs to trend usage over time and more accurately benchmark with other institutions. Furthermore, institution-specific information such as indications can be used to devise targeted stewardship interventions.
Fig 1. Antimicrobial Use by Defined Daily Doses (DDD) vs. Days of Therapy (DOT) (per 1000 patient-days) for a single LTCF in Monroe County, NY
Fig 2. Antimicrobial Use by Days of Therapy (DOT) per 1,000 patient-days for 2014 from Dispensing Data at 3 LTCFs in Monroe County, NY
C. Freeley, None
J. Burke, None
K. Thurheimer, None
N. Gohil, None
K. K. Trivedi, None
C. Felsen, None
G. Dumyati, None
E. Dodds Ashley, None
See more of: Poster Abstract Session