1831. Point Prevalence and Epidemiology of Antimicrobial Use in U.S. Nursing Homes, 2017
Session: Poster Abstract Session: Antimicrobial Stewardship: Non-hospital Settings
Saturday, October 6, 2018
Room: S Poster Hall
  • AUprevalence_NH.pdf (190.9 kB)
  • Background:  The role of nursing homes (NH) in transmission of antimicrobial resistant (AR) organisms is of growing concern.  AR control requires evidence-based NH stewardship interventions, however, data on antimicrobial use (AU) from U.S. NHs are scant. In the absence of other AU surveillance approaches, NH prevalence surveys can generate essential data, including rationale and indication. In 2017, an AU prevalence survey was conducted through the CDC's Emerging Infections Program (EIP) to determine the prevalence and epidemiology of AU in NH residents.

    Methods: NHs from CA, CO, CT, GA, MD, MN, NM, NY, OR, & TN were randomly selected to participate in a 1-day AU point prevalence survey; participation was voluntary. For NH residents receiving antimicrobial drugs (AD) at the time of the survey, EIP staff reviewed available medical records to collect the AD route, rationale, and infection site(s). AD were categorized using the World Health Organization Anatomical Therapeutic Chemical classification system. Data were analyzed in SAS 9.4.

    Results: Of 15,295 residents in 161 NHs, 1,261 (prevalence 8.2%, 95% confidence interval 7.8%-8.7%) received ≥1 AD at the time of the survey (AD range 1-4/resident). Of 1,452 total ADs, 77% were administered for treatment of an active infection, 19% for prophylaxis, 3% for non-infectious reasons, and no rationale documented in 1%. Most AD (80%) were administered by the oral/enteral route and most (87%) were antibacterials. The 3 most common infection sites were urinary tract (29%, of which 1/4 was for prophylaxis); wound, cellulitis or soft tissue (20%); and respiratory tract (14%).  Among the 1,268 antibacterials (Figure), fluoroquinolones (15%), combination penicillins (8%), 3rd generation cephalosporins (8%) and glycopepetides (5%) ranked among the top 10 classes in use.

    Conclusion: This large-scale prevalence survey provides insight into AU in U.S. NHs. On a given day, approximately 1 in 12 NH residents was receiving ≥1 AD. Notably, 30% of AD were administered for UTI, and AD  in classes recommended for stewardship intervention were common. These findings highlight areas for evaluation to identify unnecessary use in NH.  Prevalence survey data are important to inform and track the impact of stewardship interventions.


    Nicola D. Thompson, PhD1, Cedric J. Brown, MS1, Taniece Eure, MPH1, Austin Penna, MPH1, Wendy Bamberg, MD2, Grant Barney, BS3, Devra Barter, MS2, Paula Clogher, MPH4, Malini Desilva, MD, MPH5, Ghinwa Dumyati, MD, FSHEA6, Erin Epson, MD7, Linda Frank, RN8, Deborah Godine, RN8, Lourdes Irizarry, MD9, Marion A. Kainer, MBBS, MPH10, Ruth Lynfield, MD, FIDSA11, J.P. Mahoehney, MPH12, Meghan Maloney, MPH13, Susan Morabit, MSN, RN, PHCNS-BC, CIC14, Joelle Nadle, MPH8, Valerie L.S. Ocampo, RN, MIPH15, Rebecca Pierce, PhD16, Susan M. Ray, MD, FIDSA17, Sarah Shrum, MPH18, Marla Sievers, MD9, Lucy E. Wilson, MD, ScM19, Nimalie D. Stone, MD MS1 and Shelley S. Magill, MD, PhD1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Colorado Department of Public Health and Environment, Denver, CO, (3)NY Emerging Infections Program, Center for Community Health, University of Rochester Medical Center, Rochester, NY, (4)Yale, New Haven, CT, (5)Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, MN, (6)NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, NY, (7)Healthcare-Associated Infections Program, California Department of Public Health, Richmond, CA, (8)California Emerging Infections Program, Oakland, CA, (9)New Mexico EIP/Department of Health, Santa Fe, NM, (10)Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, TN, (11)Minnesota Department of Health, St. Paul, MN, (12)Minnesota EIP/Department of Health, Minneapolis, MN, (13)Connecticut Department of Public Health, Hartford, CT, (14)Georgia Emerging Infections Program, Decatur, GA, (15)Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR, (16)Public Health Division, Oregon Health Authority, Portland, OR, (17)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (18)New Mexico Department of Health, Santa Fe, NM, (19)Maryland Department of Health, Baltimore, MD


    N. D. Thompson, None

    C. J. Brown, None

    T. Eure, None

    A. Penna, None

    W. Bamberg, None

    G. Barney, None

    D. Barter, None

    P. Clogher, None

    M. Desilva, None

    G. Dumyati, None

    E. Epson, None

    L. Frank, None

    D. Godine, None

    L. Irizarry, None

    M. A. Kainer, None

    R. Lynfield, None

    J. P. Mahoehney, None

    M. Maloney, None

    S. Morabit, None

    J. Nadle, None

    V. L. S. Ocampo, None

    R. Pierce, None

    S. M. Ray, None

    S. Shrum, None

    M. Sievers, None

    L. E. Wilson, None

    N. D. Stone, None

    S. S. Magill, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.