scholarly journals Constitutional Symptoms Trigger Diagnostic Testing Before Antibiotic Prescribing in High-Risk Nursing Home Residents

2016 ◽  
Vol 64 (10) ◽  
pp. 1975-1980 ◽  
Author(s):  
Angela C. Eke-Usim ◽  
Mary A.M. Rogers ◽  
Kristen E. Gibson ◽  
Christopher Crnich ◽  
Lona Mody ◽  
...  
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Diagnostic Testing ◽  
Nursing Home Residents ◽  
Antibiotic Prescribing

scholarly journals Antibiotic Susceptibility of Common Organisms Isolated from Urine Cultures of Nursing Home Residents

2020 ◽  
Vol 41 (S1) ◽  
pp. s118-s120
Author(s):  
Austin R. Penna ◽  
Taniece R. Eure Eure ◽  
Nimalie D. Stone ◽  
Grant Barney ◽  
Devra Barter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Susceptibility ◽  
Clinical Decision Making ◽  
Service Providers ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Prescribing ◽  
E Coli ◽  
Susceptibility Data

Background: With the emergence of antibiotic resistant threats and the need for appropriate antibiotic use, laboratory microbiology information is important to guide clinical decision making in nursing homes, where access to such data can be limited. Susceptibility data are necessary to inform antibiotic selection and to monitor changes in resistance patterns over time. To contribute to existing data that describe antibiotic resistance among nursing home residents, we summarized antibiotic susceptibility data from organisms commonly isolated from urine cultures collected as part of the CDC multistate, Emerging Infections Program (EIP) nursing home prevalence survey. Methods: In 2017, urine culture and antibiotic susceptibility data for selected organisms were retrospectively collected from nursing home residents’ medical records by trained EIP staff. Urine culture results reported as negative (no growth) or contaminated were excluded. Susceptibility results were recorded as susceptible, non-susceptible (resistant or intermediate), or not tested. The pooled mean percentage tested and percentage non-susceptible were calculated for selected antibiotic agents and classes using available data. Susceptibility data were analyzed for organisms with ≥20 isolates. The definition for multidrug-resistance (MDR) was based on the CDC and European Centre for Disease Prevention and Control’s interim standard definitions. Data were analyzed using SAS v 9.4 software. Results: Among 161 participating nursing homes and 15,276 residents, 300 residents (2.0%) had documentation of a urine culture at the time of the survey, and 229 (76.3%) were positive. Escherichia coli, Proteus mirabilis, Klebsiella spp, and Enterococcus spp represented 73.0% of all urine isolates (N = 278). There were 215 (77.3%) isolates with reported susceptibility data (Fig. 1). Of these, data were analyzed for 187 (87.0%) (Fig. 2). All isolates tested for carbapenems were susceptible. Fluoroquinolone non-susceptibility was most prevalent among E. coli (42.9%) and P. mirabilis (55.9%). Among Klebsiella spp, the highest percentages of non-susceptibility were observed for extended-spectrum cephalosporins and folate pathway inhibitors (25.0% each). Glycopeptide non-susceptibility was 10.0% for Enterococcus spp. The percentage of isolates classified as MDR ranged from 10.1% for E. coli to 14.7% for P. mirabilis. Conclusions: Substantial levels of non-susceptibility were observed for nursing home residents’ urine isolates, with 10% to 56% reported as non-susceptible to the antibiotics assessed. Non-susceptibility was highest for fluoroquinolones, an antibiotic class commonly used in nursing homes, and ≥ 10% of selected isolates were MDR. Our findings reinforce the importance of nursing homes using susceptibility data from laboratory service providers to guide antibiotic prescribing and to monitor levels of resistance.Disclosures: NoneFunding: None

Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 073346482110182
Author(s):  
Sainfer Aliyu ◽  
Jasmine L. Travers ◽  
S. Layla Heimlich ◽  
Joanne Ifill ◽  
Arlene Smaldone
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Antibiotic Stewardship ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Meta Analyses

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

scholarly journals Measuring Antibiotic Appropriateness for Urinary Tract Infections in Nursing Home Residents

2017 ◽  
Vol 38 (8) ◽  
pp. 998-1001 ◽  
Author(s):  
Taniece Eure ◽  
Lisa L. LaPlace ◽  
Richard Melchreit ◽  
Meghan Maloney ◽  
Ruth Lynfield ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Nursing Home ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Nursing Home Residents ◽  
Infect Control Hosp ◽  
Antibiotic Prescribing ◽  
Appropriate Use ◽  
Tract Infections

We assessed the appropriateness of initiating antibiotics in 49 nursing home (NH) residents receiving antibiotics for urinary tract infection (UTI) using 3 published algorithms. Overall, 16 residents (32%) received prophylaxis, and among the 33 receiving treatment, the percentage of appropriate use ranged from 15% to 45%. Opportunities exist for improving UTI antibiotic prescribing in NH.Infect Control Hosp Epidemiol 2017;38:998–1001

1035-P: HbA1c Does Not Identify Nursing Home Residents at High Risk of Hypoglycemia and Hyperglycemia

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 1035-P
Author(s):  
ALEXANDRA K. LEE ◽  
SEI J. LEE ◽  
BOCHENG JING ◽  
MEDHA MUNSHI ◽  
ANDREW J. KARTER
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents

Hospitalization for Pneumonia Carries High Risk of Severe Disability and Death for Nursing Home Residents

2020 ◽  
Vol 21 (3) ◽  
pp. B31
Author(s):  
Matthew Griffith ◽  
Matthew Griffith ◽  
Cari Levy ◽  
Toral Parikh ◽  
Pedro Gozalo ◽  
...  
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents ◽  
Severe Disability

scholarly journals Screening for atrial fibrillation in high-risk nursing home residents

2020 ◽  
Vol 1 (1) ◽  
pp. 10-13
Author(s):  
Hassan A. Khan ◽  
Nader Hanna ◽  
Michael J. Chaskes ◽  
Gregory D. Gudleski ◽  
Piotr Karmilowicz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents

scholarly journals The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection

2019 ◽  
Vol 70 (8) ◽  
pp. 1620-1627 ◽  
Author(s):  
Kevin Antoine Brown ◽  
Nick Daneman ◽  
Kevin L Schwartz ◽  
Bradley Langford ◽  
Allison McGeer ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Regression Models ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Before And After

Abstract Background Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. Methods We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering &gt;90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. Results A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18–1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28–1.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07–1.31). Conclusions Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection.

scholarly journals Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents

JAMA ◽  
2011 ◽  
Vol 306 (2) ◽  
Author(s):  
Yue Li ◽  
Jun Yin ◽  
Xueya Cai ◽  
Helena Temkin-Greener ◽  
Dana B. Mukamel
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Pressure Ulcers ◽  
Nursing Home Residents
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