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. 2008 Feb 25;168(4):357-62.
doi: 10.1001/archinternmed.2007.104.

Patterns of antimicrobial use among nursing home residents with advanced dementia

Erika D'Agata  1 , Susan L Mitchell
Affiliations

Patterns of antimicrobial use among nursing home residents with advanced dementia

Erika D'Agata et al. Arch Intern Med. .

Abstract

Background: Nursing home residents with advanced dementia are at high risk of infections and antimicrobial exposure near the end of life. Detailed studies quantifying antimicrobial prescribing practices among these residents have not been performed.

Methods: A cohort of 214 residents with advanced dementia from 21 Boston-area nursing homes were followed up prospectively for 18 months or until death. We analyzed antimicrobial use, including type, indication, and quantity, by days of therapy per 1000 resident-days.

Results: During an average of 322 days of follow-up, 142 residents (66.4%) with advanced dementia received at least 1 course of antimicrobial therapy (mean [SD] number of courses per resident, 4.0 [3.7]). The mean (SD) number of days of therapy per 1000 resident-days for the entire cohort was 53.0 (4.3). Quinolones and third-generation cephalosporins were the most commonly prescribed antimicrobials, accounting for 38.3% and 15.2%, respectively, of 540 prescribed antimicrobial therapy courses. A respiratory tract infection was the most common indication (46.7% of all antimicrobial therapy courses). Among 99 decedents, 42 (42.4%) received antimicrobials during the 2 weeks before death, of which 30 of 72 courses (41.7%) were administered via the parenteral route. The number of decedents receiving antimicrobials (P < .001), the number of antimicrobials prescribed (P = .01), and the days of therapy per 1000 resident-days (P < .001) increased significantly as subjects approached death.

Conclusions: Persons with advanced dementia are frequently exposed to antimicrobials, especially during the 2 weeks before death. The implications of this practice from the perspective of the individual treatment burden near the end of life and its contribution to the emergence of antimicrobial resistance in the nursing home setting need further evaluation.

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Figures

Figure 1
Figure 1
Percentages of nursing home residents with advanced dementia receiving antimicrobials and of antimicrobial therapy courses, among a total of 126 courses prescribed, during the last 8 weeks of life. The total number of residents and antimicrobial courses during each 14-day interval before death were as follows: 99 and 10 at 0 to 14 days; 94 and 19 at 15 to 28 days; 88 and 25 at 29 to 42 days; and 83 and 72 at 43 to 56 days, respectively.
Figure 2
Figure 2
Days of therapy (DOT) per 1000 resident-days for any antimicrobial received by nursing home residents with advanced dementia during the last 8 weeks of life. The total number of subjects at each 14-day interval before death was as follows: 99 at 0 to 14 days; 94 at 15 to 28 days; 88 at 29 to 42 days; and 83 at 43 to 56 days.
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References

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