680. Antibiotic Use Data From 30 Community Long-Term Care Facilities Suggests Initial Targets for Antibiotic Stewardship Programs
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • IDWEEK_2017_final.pdf (1.8 MB)
  • Background: By November 28th2017, long-term care facilities (LTCFs) in the United States must establish and maintain an antibiotic stewardship program that employs antibiotic use protocols and a system for monitoring their use. Currently, little is known about how LTCFs in the United States use antibiotics. Here, we use prescription invoice data from 2014 to describe antibiotic use among 30 community LTCFs in the same network.

    Methods: We determined the proportion of prescriptions of antibiotics to other systemic medications as well as length of therapy for antibiotic prescriptions. Rates of antibiotic use were calculated as days of antibiotic therapy (DOT) per 1000 bed days of care (BDOC). The data were stratified by the size of the LTCFs.

    Results: Across all facilities, the proportion of prescriptions for antibiotics was, on average, 10% (range 6 – 24%). For length of therapy, 4% of antibiotics were prescribed for >14 days (range 0.3 to 9.7%). Fluoroquinolones were the most frequently prescribed class of antibiotic in 20 of 30 (67%) of LTCFs.

    Table: Antibiotic Use Stratified by LTCF size

    LTCFs by Number of Beds

    <100 beds

    (n = 9)

    100-150 beds

    (n = 11)

    >150 beds

    (n = 10)

    Proportion of Prescriptions for Antibiotics (Mean, Range)

    10.3% (7.2 - 22.2)

    10.3% (6.7 – 23.7)

    9.3% (6.0 – 16.8)

    Length of Antibiotic Therapy (Mean, Range)

    1 – 3 days

    58.2% (47.3 – 85.9)

    55.1% (47.2 – 90.0)

    55.4% (43.0 – 85.3)

    4 – 7 days

    22.8% (9.5 – 33.6)

    27.1% (7.6 – 36.2)

    26.6% (8.2 – 36.0)

    8 – 14 days

    15.3% (4.3 – 20.2)

    13.7% (1.8 – 18.2)

    13.2% (4.8 – 20.1)

    >14 days

    3.7% (0.3 – 6.4)

    4.1% (0.6 - 9.7)

    4.8% (1.6 – 8.4)

    Days of Antibiotic Therapy/1000 Bed Days of Care (Mean, Range)

    Oral

    67.2 (15.0 – 104.8)

    79.8 (18.9 – 199.8)

    46.3 (15.5 – 85.9)

    Intravenous

    10.0 (1.5 – 13.0)

    13.4 (3.4 – 27.7)

    11.1 (2.1 – 24.5)

    Conclusion: There is considerable variation in the proportion of antibiotics prescriptions, length of therapy and rate of antibiotic use among LTCFs within the same network. While these data derived from pharmacy invoices have some limitations, they suggest that antibiotic prescriptions for longer than 14 days and fluoroquinolones are reasonable targets for initial antibiotic stewardship efforts in LTCFs.

    Rebecca Carter, B.A., Epidemiology and Biostatistics, Case Western School of Medicine, Cleveland, OH, Joesph Marek, RPh, American Society of Consultant Pharmacists, Cleveland, OH and Robin Jump, M.D., Ph.D., Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH

    Disclosures:

    R. Carter, None

    J. Marek, None

    R. Jump, 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.