Nicola D Thompson1, Austin Penna2, Taniece R Eure2, Wendy M Bamberg3, Grant Barney4, Devra Barter3, Paula Clogher5, Malini B DeSilva6, Ghinwa Dumyati7, Erin Epson8, Linda Frank9, Deborah Godine9, Lourdes Irizarry10, Marion A Kainer11, Linda Li12, Ruth Lynfield6, J P Mahoehney6, Joelle Nadle9, Valerie Ocampo13, Lewis Perry14, Susan M Ray15, Sarah Shrum Davis10, Marla Sievers10, Lucy E Wilson12, Alexia Y Zhang13, Nimalie D Stone2, Shelley S Magill2. 1. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: dvq0@cdc.gov. 2. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 3. Colorado Department of Public Health and Environment, Denver, CO. 4. New York Emerging Infections Program, Rochester, NY. 5. Connecticut Emerging Infections Program and the Yale School of Public Health, New Haven, CT. 6. Minnesota Department of Health, St Paul, MN. 7. New York Emerging Infections Program, Rochester, NY; University of Rochester, Rochester, NY. 8. California Department of Health, Richmond, CA. 9. California Emerging Infections Program, Oakland, CA. 10. New Mexico Department of Health, Santa Fe, NM. 11. Tennessee Department of Health, Nashville, TN. 12. Maryland Department of Health, Baltimore, MD. 13. Oregon Health Authority, Portland, OR. 14. Georgia Emerging Infections Program, Atlanta, GA. 15. Georgia Emerging Infections Program, Atlanta, GA; Emory University, Atlanta, GA.
Abstract
OBJECTIVES: Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. DESIGN: Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. SETTING AND PARTICIPANTS: Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). METHODS: EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. RESULTS: Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. CONCLUSIONS AND IMPLICATIONS: One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship. Published by Elsevier Inc.
OBJECTIVES: Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. DESIGN: Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. SETTING AND PARTICIPANTS: Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). METHODS: EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. RESULTS: Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. CONCLUSIONS AND IMPLICATIONS: One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship. Published by Elsevier Inc.
Authors: Austin R Penna; Christina L Sancken; Nimalie D Stone; Taniece R Eure; Wendy Bamberg; Grant Barney; Devra Barter; Stacy Carswell; Paula Clogher; Ghinwa Dumyati; Christina B Felsen; Linda Frank; Deborah Godine; Helen Johnston; Marion A Kainer; Linda Li; Ruth Lynfield; J P Mahoehney; Joelle Nadle; Rebecca Pierce; Susan M Ray; Sarah Shrum Davis; Marla Sievers; Lucy E Wilson; Alexia Y Zhang; Shelley S Magill; Nicola D Thompson Journal: Infect Control Hosp Epidemiol Date: 2020-04-28 Impact factor: 3.254
Authors: Nicola D Thompson; Nimalie D Stone; Cedric J Brown; Austin R Penna; Taniece R Eure; Wendy M Bamberg; Grant R Barney; Devra Barter; Paula Clogher; Malini B DeSilva; Ghinwa Dumyati; Linda Frank; Christina B Felsen; Deborah Godine; Lourdes Irizarry; Marion A Kainer; Linda Li; Ruth Lynfield; J P Mahoehney; Meghan Maloney; Joelle Nadle; Valerie L S Ocampo; Rebecca Pierce; Susan M Ray; Sarah Shrum Davis; Marla Sievers; Krithika Srinivasan; Lucy E Wilson; Alexia Y Zhang; Shelley S Magill Journal: JAMA Date: 2021-04-06 Impact factor: 56.272
Authors: Pranita D Tamma; Melissa A Miller; Prashila Dullabh; Roy Ahn; Kathleen Speck; Yue Gao; Erik Scherpf; Sara E Cosgrove Journal: JAMA Netw Open Date: 2021-02-01