Columbia University School of Nursing, Center for Health Policy, New York, NY, USA.
Economics, Sociology & Statistics, RAND Corporation, Washington, DC, USA.
J Am Med Dir Assoc. 2022 Mar;23(3):482-487. doi: 10.1016/j.jamda.2021.06.031. Epub 2021 Jul 21.
Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship programs is a national priority. Our aim is to evaluate the influence of antibiotic stewardship programs on antibiotic use rates in NHs over time.
Retrospective, repeated cross-sectional analysis.
Long-term residents not receiving hospice care in freestanding NHs that participated in 1 or both surveys in 2013 and 2017.
Survey data were merged with the Minimum Data Set and the Certification and Survey Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic use. The main predictor was the NH antibiotic stewardship policy intensity. Using multivariate linear regression models adjusting for resident and facility characteristics that differed between the 2 years, we calculated antibiotic use rates in 2013 and 2017 for all residents, those with Alzheimer's disease, and those with any infection including urinary tract infections (UTIs).
Our sample included 317,003 resident assessments from 2013 and 267,537 assessments from 2017, residing in 953 and 872 NHs, respectively. NH antibiotic stewardship policy intensity increased from 2013 to 2017 (P < .01) and among all NH residents, including those with Alzheimer's disease, antibiotic use rate decreased (P < .05), with 45% of the decline attributable to strengthening stewardship programs. For most residents, policy intensity was associated with decreased usage in residents with UTI. However, among Alzheimer's disease residents with a UTI, this association did not persist.
Although there was a decrease in antibiotic use in 2017, more time is needed to see the full impact of antibiotic stewardship policy into practice. Adjustments to programs that directly address barriers to implementation and appropriate UTI antibiotic use for residents with Alzheimer's disease are necessary to continue strengthening NH antibiotic stewardship and improve care.
通过实施管理计划来减少不适当的养老院（NH）抗生素使用是国家的重点。我们的目的是评估抗生素管理计划对 NH 中抗生素使用率随时间的影响。
回顾性、重复横断面分析。
在独立 NH 中接受临终关怀的长期居民，他们参加了 2013 年和 2017 年的一项或两项调查。
调查数据与最低数据集和认证与调查提供方强化报告数据合并。我们的结果是抗生素使用的二进制指标。主要预测因素是 NH 抗生素管理政策的强度。使用多元线性回归模型，根据 2 年之间存在差异的居民和设施特征进行调整，我们计算了所有居民、患有阿尔茨海默病的居民和患有任何感染（包括尿路感染）的居民在 2013 年和 2017 年的抗生素使用率。
我们的样本包括来自 2013 年的 317003 名居民评估和来自 2017 年的 267537 名居民评估，分别居住在 953 家和 872 家 NH 中。NH 抗生素管理政策强度从 2013 年到 2017 年增加（P <.01），并且在所有 NH 居民中，包括患有阿尔茨海默病的居民，抗生素使用率下降（P <.05），其中 45%的下降归因于加强管理计划。对于大多数居民，政策强度与患有尿路感染的居民的使用率降低有关。然而，对于患有尿路感染的阿尔茨海默病居民，这种关联并不持续。
尽管 2017 年抗生素使用有所减少，但还需要更多时间才能看到抗生素管理政策全面实施的影响。需要对计划进行调整，以直接解决实施障碍和适当使用针对患有阿尔茨海默病的居民的尿路感染抗生素，以继续加强 NH 抗生素管理并改善护理。
