Behavioral & Policy Sciences, RAND Corporation, Santa Monica, California.
Economics, Sociology & Statistics, RAND Corporation, Boston, Massachusetts.
Infect Control Hosp Epidemiol. 2021 Mar;42(3):311-317. doi: 10.1017/ice.2020.422. Epub 2020 Sep 16.
Antibiotics are overly prescribed in nursing homes. Recent antibiotic stewardship efforts attempt to reduce inappropriate use. Our objective was to describe antibiotic use from 2012 to 2016 among nursing-home residents with various health conditions.
Retrospective, repeated cross-sectional analysis.
All long-term residents in a random 10% sample of national nursing homes: 2,092,809 assessments from 319,615 nursing-home residents in 1,562 nursing homes.
We calculated a 1-day antibiotic prevalence using all annual and quarterly clinical assessments in the Minimum Data Set (MDS) from April 2012 through December 2016. We calculated prevalence of antibiotic use overall and within conditions of interest: Alzheimer's disease and related dementias (ADRD), advanced cognitive impairment (ACI), and infections likely to be treated with antibiotics. We applied logistic regressions with nursing-home cluster, robust standard errors to assess changes in conditions and antibiotic use 2012-2016.
Overall, antibiotic use did not change (2012 vs 2016, adjusted odds ratio [AOR], 1.00; 95% CI, 0.97-1.03). Antibiotic use was higher in 2016 versus 2012 among assessments with any infection (AOR, 1.10; 95% CI, 1.04-1.16), urinary tract infection (AOR, 1.18; 95% CI, 1.12-1.25), and no infection (AOR, 1.13; 95% CI, 1.09-1.17). Results were similar by cognitive status.
The increased proportion of assessments recording antibiotics but no infection may not be clinically appropriate. Higher antibiotic use among infected residents with advanced cognitive impairment is also concerning. Further efforts to understand mechanisms driving these trends and to promote antibiotic stewardship in nursing homes are warranted.
养老院过度开具抗生素处方。最近的抗生素管理工作旨在减少不合理使用。我们的目的是描述 2012 年至 2016 年间患有各种健康状况的养老院居民的抗生素使用情况。
回顾性、重复横断面分析。
所有长期居住在全国随机抽取的 10%养老院样本中的居民：1562 家养老院的 319615 名养老院居民的 2092809 项评估。
我们使用 MDS 中的所有年度和季度临床评估计算了 1 天抗生素的流行率。我们计算了抗生素的总体使用情况和以下情况下的使用情况：阿尔茨海默病和相关痴呆症（ADRD）、高级认知障碍（ACI）和可能需要抗生素治疗的感染。我们应用了带有养老院集群的逻辑回归，使用稳健标准误差来评估 2012-2016 年期间的情况和抗生素使用变化。
总体而言，抗生素的使用没有变化（2012 年与 2016 年相比，调整后的优势比 [AOR]，1.00；95%置信区间，0.97-1.03）。在有任何感染（AOR，1.10；95%置信区间，1.04-1.16）、尿路感染（AOR，1.18；95%置信区间，1.12-1.25）和无感染（AOR，1.13；95%置信区间，1.09-1.17）的评估中，2016 年的抗生素使用高于 2012 年。结果按认知状态相似。
记录抗生素但无感染的评估比例增加可能不符合临床要求。在认知障碍严重的感染居民中，抗生素的使用较高也令人担忧。需要进一步努力了解推动这些趋势的机制，并促进养老院的抗生素管理。
