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Clinical Trial
. 2012 Dec;33(12):1185-92.
doi: 10.1086/668429. Epub 2012 Oct 25.

Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use

Robin L P Jump  1 , Danielle M Olds, Nasim Seifi, Georgios Kypriotakis, Lucy A Jury, Emily P Peron, Amy A Hirsch, Paul E Drawz, Brook Watts, Robert A Bonomo, Curtis J Donskey
Affiliations
Clinical Trial

Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use

Robin L P Jump et al. Infect Control Hosp Epidemiol. 2012 Dec.

Abstract

Design: We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.

Setting: A 160-bed VA LTCF.

Methods: Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.

Results: Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P=.008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β-lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P=.04).

Conclusions: Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.

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Conflict of interest statement

Potential Conflicts of Interest

RLPJ reports having consulted for GOJO and Pfizer and has received grant support from Steris, Merck and ViroPharma. RAB reports having consulted for AstraZeneca and having received grant support from AstraZeneca, Ribx, Pfizer and Steris. CJD reports having consulted for BioK, Optimer and GOJO and has received grant support from ViroPharma, Merck and Pfizer. All remaining authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.

Figures

Figure 1
Figure 1
Observed rates of antibiotic use before and after initiation of the LID Consult Service, shown as black and white symbols, respectively, in the (A) LTCF and the (B) hospital. The corresponding lines and their slopes (indicated on the graph) represent the estimated rates of change in antimicrobial use for total antimicrobials (squares), oral agents (diamonds) and intravenous agents (circles), determined using segmented regression analysis of an interrupted time series. * P ≤ .05.
Figure 2
Figure 2
Comparison of mean antimicrobial use for (A) fluoroquinolones, (B) other non-beta-lactams and (C) beta-lactam antimicrobials. Bars depict the mean days of therapy/1000 days of care for drug classes before and after the LID consult service for drug classes (black and white bars, respectively) and for individual antibiotics (dark and light grey bars, respectively). *, with Bonferroni correction, significant P-value ≤ .0017.
Figure 3
Figure 3
Observed rates of change in positive C. difficile tests at the LTCF (squares) and hospital (triangles) before (black symbols) and after (white symbols) initiation of the LID Consult Service. The corresponding lines and their slopes (noted on graph) represent the estimated rates of change for positive C. difficile tests at the LTCF (solid lines) and the hospital (dashed lines), determined using segmented regression analysis of an interrupted time series. * P ≤ .05.
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