676. Protecting Our Most Vulnerable: Why Antimicrobial Stewardship for Senior Living is a Must – Results from Four Large Senior Living Centers
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • IDSAposter-seniorliving-2017.pdf (103.4 kB)
  • Background:

    Antibiotics are frequently prescribed among senior living residents, with the over diagnosis of infections playing a significant problem. Elderly are vulnerable to the harms of inappropriate antibiotic use.

    Methods:

    We evaluated the use of systemic antibiotics, the diagnosis of facility-onset urinary tract infection (based on McGeer’s criteria), and C. difficile infections in the 4 large (>250 resident beds) Senior Living Centers in 4 different states. All measures were normalized per 1,000 resident-days and evaluated over 9 months between July 2015 and March 2016. In addition, we visited the 4 facilities and qualitatively evaluated factors that may influence antibiotic use.

    Results:

    There were 27,255 antibiotic-days at a rate of 106.8 per 1,000 resident-days. Non-quinolone antiurinary agents accounted for 22.3 (20.9%), quinolones for 21.5 (20.2%), cephalosporins 16.8 (15.7%), penicillins 8.0 (7.5%), and tetracyclines 8.2 (7.7%), and macrolides 6.31 (5.9%) antibiotic-days per 1,000 resident-days. There were marked differences in use of urinary antimicrobials between the 4 facilities (Figure 1). Facility A and B had more than 6 times antibiotic use compared to facility D, and had the highest rates for UTI (Table 1). Clostridium difficile infections were highest in facility A compared to other facilities. The two facilities lowest antimicrobial use had strong physician-nursing partnership with engaged medical directors.

    Conclusion:

    Considerable opportunities reside in Senior Living to optimize testing and appropriate antibiotic use. Engaging both nurses and physicians, in addition to regular evaluation of use with feedback are key to standardizing the care and improving the outcomes.

    Table 1: Antimicrobial Use, Urinary Tract Infections, and Clostridium difficile Infections at the 4 Facilities.

     

    Facility A

    Facility B

    Facility C

    Facility D

    P-value

    Antibiotic-Days

    11,087

    9,439

    5,109

    1,620

     

    Urinary Tract Infections

    106

    143

    31

    32

     

    Clostridium difficile Infections

    16

    4

    6

    0

     

    Resident-Days

    63,906

    57,871

    67,007

    66,411

     

    Antibiotic Days per 1,000 Resident-Days

    173.5

    163.1

    76.3

    24.4

    <0.001

    UTIs per 1,000 Resident-Days

    1.66

    2.47

    0.46

    0.48

    <0.001

    C. difficile per 1,000 Resident-days

    0.25

    0.07

    0.09

    0

    0.001

    Figure 1: Nitrofurantoin, TMP/Sulfa and Quinolone Rates for the 4 Facilities

     

    Roy Guharoy, PharmD, MBA1, Rita Vann, RN2, Suzanne Miller, CPA2, Clariecia Groves, M.S.3, Lisa Sturm, MPH4, Kevin O'Neil, MD5, Ann Hendrich, PhD, RN4 and Mohamad Fakih, MD, MPH4, (1)Medicine, University of Massachusetts Medical School, Worcester, MA, (2)Ascension, St. Louis, MO, (3)Care Excellence, Ascension Health, St Louis, MO, (4)Care Excellence, Ascension Healthcare, St. Louis, MO, (5)Senior Care, Ascenion Health, St. Louis, MO

    Disclosures:

    R. Guharoy, None

    R. Vann, None

    S. Miller, None

    C. Groves, None

    L. Sturm, None

    K. O'Neil, None

    A. Hendrich, None

    M. Fakih, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.