1BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI USA.
2University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI USA.
Antimicrob Resist Infect Control. 2018 Jun 14;7:74. doi: 10.1186/s13756-018-0364-7. eCollection 2018.
The pervasive, often inappropriate, use of antibiotics in healthcare settings has been identified as a major public health threat due to the resultant widespread emergence of antibiotic resistant bacteria. In nursing homes (NH), as many as two-thirds of residents receive antibiotics each year and up to 75% of these are estimated to be inappropriate. The objective of this study was to characterize antibiotic therapy for NH residents and compare appropriateness based on setting of prescription initiation.
This was a retrospective, cross-sectional multi-center study that occurred in five NHs in southern Wisconsin between January 2013 and September 2014. All NH residents with an antibiotic prescribing events for suspected lower respiratory tract infections (LRTI), skin and soft tissue infections (SSTI), and urinary tract infections (UTI), initiated in-facility, from an emergency department (ED), or an outpatient clinic were included in this sample. We assessed appropriateness of antibiotic prescribing using the Loeb criteria based on documentation available in the NH medical record or transfer documents. We compared appropriateness by setting and infection type using the Chi-square test and estimated associations of demographic and clinical variables with inappropriate antibiotic prescribing using logistic regression.
Among 735 antibiotic starts, 640 (87.1%) were initiated in the NH as opposed to 61 (8.3%) in the outpatient clinic and 34 (4.6%) in the ED. Inappropriate antibiotic prescribing for urinary tract infections differed significantly by setting: NHs (55.9%), ED (73.3%), and outpatient clinic (80.8%), = .023. Regardless of infection type, patients who had an antibiotic initiated in an outpatient clinic had 2.98 (95% CI: 1.64-5.44, < .001) times increased odds of inappropriate use.
Antibiotics initiated out-of-facility for NH residents constitute a small but not trivial percent of all prescriptions and inappropriate use was high in these settings. Further research is needed to characterize antibiotic prescribing patterns for patients managed in these settings as this likely represents an important, yet under recognized, area of consideration in attempts to improve antibiotic stewardship in NHs.
由于抗生素耐药菌的广泛出现，医疗保健环境中普遍存在且往往不适当的抗生素使用已被确定为主要的公共卫生威胁。在养老院（NH）中，多达三分之二的居民每年接受抗生素治疗，其中估计多达 75%的抗生素治疗是不适当的。本研究的目的是描述 NH 居民的抗生素治疗，并根据处方启动的环境比较其适当性。
这是一项回顾性、横断面多中心研究，于 2013 年 1 月至 2014 年 9 月在威斯康星州南部的五家 NH 中进行。所有在 NH 中接受疑似下呼吸道感染（LRTI）、皮肤和软组织感染（SSTI）和尿路感染（UTI）抗生素治疗的居民，包括从急诊室（ED）或门诊诊所开始在机构内启动的抗生素治疗均纳入本样本。我们使用 Loeb 标准评估抗生素处方的适当性，该标准基于 NH 病历或转科文件中的可用文档。我们使用卡方检验比较了不同环境和感染类型的适当性，并使用逻辑回归估计人口统计学和临床变量与不适当抗生素处方的关联。
在 735 例抗生素治疗开始中，有 640 例（87.1%）是在 NH 中开始的，而 61 例（8.3%）是在门诊诊所开始的，34 例（4.6%）是在 ED 中开始的。不同环境下，尿路感染抗生素处方的不适当性有显著差异：NH（55.9%）、ED（73.3%）和门诊诊所（80.8%），=0.023。无论感染类型如何，在门诊诊所开始抗生素治疗的患者，其不适当使用的可能性增加 2.98 倍（95%CI：1.64-5.44， < 0.001）。
NH 居民在机构外开始的抗生素治疗占所有处方的比例很小，但并非微不足道，这些环境中的不适当使用比例很高。需要进一步研究这些环境中患者的抗生素治疗模式，因为这可能是在 NH 中尝试改善抗生素管理以提高抗生素管理水平的一个重要但尚未得到充分认识的领域。
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