Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

2018 ◽  
Vol 40 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Bo R. Weber ◽  
Brie N. Noble ◽  
David T. Bearden ◽  
Christopher J. Crnich ◽  
Katherine D. Ellingson ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Long Term Care ◽  
Antibiotic Prescription ◽  
Antibiotic Prescribing ◽  
Day Hospital ◽  
Post Discharge ◽  
Term Care ◽  
Increased Risk ◽  
Care Facilities

AbstractObjectiveTo quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).DesignRetrospective cohort study.SettingA 576-bed, academic hospital in Portland, Oregon.PatientsAdult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.MethodsOur primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.ResultsAmong 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).ConclusionsAntibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

scholarly journals Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Laura W van Buul ◽  
Jenny T van der Steen ◽  
Sarah MMM Doncker ◽  
Wilco P Achterberg ◽  
François G Schellevis ◽  
...  
Keyword(s):  
Long Term Care ◽  
Antibiotic Prescribing ◽  
Term Care ◽  
Factors Influencing ◽  
Care Facilities ◽  
Depth Study

scholarly journals Case–control study to estimate odds of death within 28 days of positive test for SARS-CoV-2 prior to vaccination for residents of long-term care facilities in England, 2020–2021

2021 ◽  
pp. jech-2021-218135
Author(s):  
Karthik Paranthaman ◽  
Hester Allen ◽  
Dimple Chudasama ◽  
Neville Q Verlander ◽  
James Sedgwick
Keyword(s):  
Long Term Care ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Positive Test ◽  
Mortality Data ◽  
Multivariable Logistic Regression Analysis ◽  
Term Care ◽  
Increased Risk ◽  
Care Facilities

BackgroundPersons living in long-term care facilities (LTCFs) are presumed to be at higher risk of adverse outcomes from SARS-CoV-2 infection due to increasing age and frailty, but the magnitude of increased risk is not well quantified.MethodsAfter linking demographic and mortality data for cases with confirmed SARS-CoV-2 infection between March 2020 and January 2021 in England, a random sample of 6000 persons who died and 36 000 who did not die within 28 days of a positive test was obtained from the dataset of 3 020 800 patients. Based on an address-matching process, the residence type of each case was categorised into one of private home and residential or nursing LTCF. Univariable and multivariable logistic regression analysis was conducted.ResultsMultivariable analysis showed that an interaction effect between age and residence type determined the outcome. Compared with a 60-year-old person not living in LTCF, the adjusted OR (aOR) for same-aged persons living in residential and nursing LTCFs was 1.77 (95% CI 1.21 to 2.6, p=0.0017) and 3.95 (95% CI 2.77 to 5.64, p<0.0001), respectively. At 90 years of age, aORs were 0.87 (95% CI 0.72 to 1.06, p=0.21) and 0.74 (95% CI 0.61 to 0.9, p=0.001), respectively. The model had an overall accuracy of 94.2% (94.2%) when applied to the full dataset of 2 978 800 patients.ConclusionThis study found that residents of LTCFs in England had higher odds of death up to 80 years of age. Beyond 80 years, there was no difference in the odds of death for LTCF residents compared with those in the wider community.

Antibiotic Use in Long-Term–Care Facilities: Many Unanswered Questions

2000 ◽  
Vol 21 (10) ◽  
pp. 680-683 ◽  
Author(s):  
Mark Loeb
Keyword(s):  
Antibiotic Resistance ◽  
Long Term Care ◽  
Diagnostic Testing ◽  
Antibiotic Use ◽  
Quantitative Relation ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Term Care ◽  
Care Facilities

AbstractThe extensive use of antibiotics in long-term–care facilities has led to increasing concern about the potential for the development of antibiotic resistance. Relatively little is known, however, about the quantitative relation between antibiotic use and resistance in this population. A better understanding of the underlying factors that account for variance in antibiotic use, unexplained by detected infections, is needed. To optimize antibiotic use, evidence-based standards for empirical antibiotic prescribing need to be developed. Limitations in current diagnostic testing for infection in residents of long-term–care facilities pose a substantial challenge to developing such standards.

scholarly journals Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities

2019 ◽  
Vol 16 (23) ◽  
pp. 4623 ◽  
Author(s):  
Jiang ◽  
Xia ◽  
Wang ◽  
Zhou ◽  
Jiang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Long Term Care ◽  
Term Care ◽  
Injurious Falls ◽  
Increased Risk ◽  
Care Facilities ◽  
Benzodiazepine Use ◽  
Risk Of Falls ◽  
One Year

Background: Falls are leading cause of injury among older people, especially for those living in long-term care facilities (LTCFs). Very few studies have assessed the effect of sleep quality and hypnotics use on falls, especially in Chinese LTCFs. The study aimed to examine the association between sleep quality, hypnotics use, and falls in institutionalized older people. Methods: We recruited 605 residents from 25 LTCFs in central Shanghai and conducted a baseline survey for sleep quality and hypnotics use, as well as a one-year follow-up survey for falls and injurious falls. Logistic regression models were applied in univariate and multivariate analysis. Results: Among the 605 participants (70.41% women, mean age 84.33 ± 6.90 years), the one-year incidence of falls and injurious falls was 21.82% and 15.21%, respectively. Insomnia (19.83%) and hypnotics use (14.21%) were prevalent. After adjusting for potential confounders, we found that insomnia was significantly associated with an increased risk of falls (adjusted risk ratio (RR): 1.787, 95% CI, 1.106–2.877) and the use of benzodiazepines significantly increased the risk of injurious falls (RR: 3.128, 95% CI, 1.541–6.350). Conclusion: In elderly LTCF residents, both insomnia and benzodiazepine use are associated with an increased risk of falls and injuries. Adopting non-pharmacological approaches to improve sleep quality, taking safer hypnotics, or strengthening supervision on benzodiazepine users may be useful in fall prevention.

Iron deficiency is associated with increased risk for cardiovascular disease and all-cause mortality in the elderly living in long-term care facilities

Nutrition ◽  
2013 ◽  
Vol 29 (5) ◽  
pp. 737-743 ◽  
Author(s):  
Hua-Shui Hsu ◽  
Chia-Ing Li ◽  
Chiu-Shong Liu ◽  
Cheng-Chieh Lin ◽  
Kuo-Chin Huang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Iron Deficiency ◽  
Long Term Care ◽  
The Elderly ◽  
Term Care ◽  
Increased Risk ◽  
Care Facilities ◽  
All Cause Mortality ◽  
Elderly Living

scholarly journals Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 680
Author(s):  
Ángel Rodríguez-Villodres ◽  
Cecilia Martín-Gandul ◽  
Germán Peñalva ◽  
Ana Belén Guisado-Gil ◽  
Juan Carlos Crespo-Rivas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Multidrug Resistant ◽  
Term Care ◽  
Extended Spectrum ◽  
Increased Risk ◽  
Modifiable Factors ◽  
Care Facilities ◽  
Multidrug Resistant Organisms

Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.

scholarly journals Antimicrobial prescribing in long-term care facilities: a nationwide point-prevalence study, Slovenia, 2016

2018 ◽  
Vol 23 (46) ◽  
Author(s):  
Dora Stepan ◽  
Lea Ušaj ◽  
Marija Petek Šter ◽  
Marjetka Smolinger Galun ◽  
Hermina Smole ◽  
...  
Keyword(s):  
Long Term Care ◽  
Antibiotic Use ◽  
Point Prevalence ◽  
Prevalence Study ◽  
Resistant Bacteria ◽  
Antibiotic Prescribing ◽  
Term Care ◽  
Point Prevalence Study ◽  
Care Facilities

Residents in long-term care are at high risk of infections because of their old age and many related health problems that lead to frequent antibiotic prescribing. The aim of the study was to assess antibiotic use in Slovenian long-term care facilities (LTCFs). The point-prevalence study was conducted between April and June 2016. Online questionnaires were sent to all Slovenian LTCFs. Eighty (68.4%) of the 117 LTCFs contacted, caring for 13,032 residents (70.6% of all Slovenian LTCF residents), responded to the survey. On the day of the study, the mean antibiotic prevalence per LTCF was 2.4% (95% confidence interval: 1.94–2.66). Most (70.2%) of the residents taking antibiotics were female. Most residents were being treated for respiratory tract (42.7%) or urinary tract (33.3%) infections. Co-amoxiclav and fluoroquinolones were the most frequently prescribed antibiotics (41.0% and 22.3% respectively). Microbiological tests were performed for 5.2% of residents receiving antibiotics. Forty nine (19.8%) residents receiving antibiotics were colonised with multidrug-resistant bacteria (MDR). Antibiotic use in Slovenian LTCFs is not very high, but most prescribed antibiotics are broad-spectrum. Together with low use of microbiological testing and high prevalence of colonisation with MDR bacteria the situation is worrisome and warrants the introduction of antimicrobial stewardship interventions.

Stewardship in the primary care and long-term care settings

2016 ◽  
Author(s):  
Naomi Fleming
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Diagnostic Tools ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Term Care ◽  
Care Facilities ◽  
Tract Infections

This chapter focuses on stewardship in the primary care and long-term care settings. Antibiotic prescribing in the community accounts for 80% total antibiotic prescribing and approximately 75% of this is for acute respiratory tract infections, many of which are viral. There is also significant variation in prescribing practices that is not explained by differences in presenting patients. These factors suggest that antimicrobial stewardship programmes are necessary. This chapter identifies the components of stewardship that have been successful in influencing antibiotic prescribing in primary care and shares local experiences with practical examples. The lack of UK evidence about antimicrobial stewardship in long-term care facilities is discussed, along with successful interventions from overseas. Challenges within these settings are highlighted, including patient demand, lack of access to microbiological and diagnostic tools, competing targets, time pressures, and clinical uncertainty.

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