Infections with multi-drug resistant organisms (MDROs) are associated with significant morbidity and mortality in acute care facilities. There is increasing recognition that residents in LTCF with multiple co-morbidities and advanced age contribute to the MDRO pool. Many factors contribute to the development of MDROs in LTCFs: challenges in assessing patients for infection, suboptimal reporting of findings to physicians, antimicrobials ordered via telephone, and the treatment of colonization.
An Antimicrobial Stewardship Program (ASP) was started for a 120-bed LTC facility associated with a 59-bed, acute-care community hospital. Prospective reviews of antimicrobial therapy with intervention began in 2011. Education was provided for all physicians, nurses, and pharmacists on the use of a LTC Fever/Suspected Infection protocol, based on the modified McGeer criteria. Guidelines were distributed in a flowchart format for respiratory, urinary, and skin & soft tissue infections. Patient assessment checklists were created for nursing, to facilitate reporting of symptoms to clinicians. Infectious disease-recommended empiric antimicrobial therapy was based on LTC antibiogram data. In addition to evaluating the effect of judicious antimicrobial use on C.difficile infection (CDI), the impact of reducing the intensity of acid suppression and increasing probiotic use was also studied. Antimicrobial use was tracked by days of therapy per 1000 patient days.
The overall LTC antimicrobial use decreased by 40% since the ASP was initiated in 2011, with significant decreases in broad-spectrum antibiotics, vancomycin, antifungals, and therapy for CDI.
Lower fluoroquinolone usage was associated with increasing E.coli susceptibility. The CDI rate decreased by 70%.
Overall, the physician acceptance of ASP recommendations increased from 79% in 2011, to 95% in 2014.
A robust, multi-disciplinary ASP can result in decreasing the number of resistant E.coli, VRE, and CDIs by improving antimicrobial use in a LTC. We have demonstrated that the benefits can be sustained over time. The success of an ASP is incumbent on significant and ongoing interdisciplinary cooperation among nursing, physicians and pharmacists.
K. Warm, None
R. Oen, None
R. Chinn, None