Background: Antibiotics are frequently prescribed inappropriately in nursing homes (NHs); however, national estimates of NH antibiotic use are limited. We aimed to describe antibiotic prescribing in U.S. NHs to identify potential targets for antibiotic stewardship.
Methods: A descriptive analysis was conducted using the 2014 proprietary IQVIA long-term care (LTC) Xponent database, which captures oral and intravenous antibiotic prescription transactions from sampled LTC pharmacies representing 70-85% of the LTC market. The data are projected to 100% of the U.S. LTC market. Denominators for rate calculations were captured from the 2014 Minimum Data Set as the number of residents with at least one resident day in a NH in 2014. Antibiotic transaction counts and rates were calculated by resident gender, age, U.S. census region, route of administration, antibiotic class and agent, and total transaction counts were summarized by provider type. Prescribing patterns for antibiotic classes and agents stratified by resident age were also calculated.
Results: In 2014 there were over 14 million antibiotic transactions in LTC pharmacies, for a rate of 3302 per 1000 residents. Female residents accounted for 62% of antibiotic transactions at a rate of 3305 transactions per 1000 residents compared to 3240 per 1000 male residents. Antibiotic prescribing was highest in the South at 3752 transactions per 1000 residents (vs. 2601 per 1000 residents in the West). Oral antibiotics accounted for 85% of transactions. Fluoroquinolones were the most frequently prescribed antibiotic class (22%; 723 transactions per 1000 residents) and the most common agents were levofloxacin, ciprofloxacin and sulfamethoxazole-trimethoprim. Stratified by age, the percent change in prescribing rates among residents aged <85 to residents aged ≥85 was largest for fluoroquinolones (645 vs. 883) and urinary anti-infectives (210 vs. 319). Internal medicine and family practice providers accounted for 37% and 32% of all antibiotic transactions, respectively.
Conclusion: A potential antibiotic stewardship target in NHs is fluoroquinolone prescribing. Targeting states in the South for interventions may have the largest impact.
Figure. Antibiotic prescribing rates in long-term care by U.S. census regions
M. Bartoces, None
D. Y. Hyun, None
J. Baggs, None
N. D. Stone, None
L. A. Hicks, None