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. 2021 Mar;42(3):311-317.
doi: 10.1017/ice.2020.422. Epub 2020 Sep 16.

Trends in antibiotics use among long-term US nursing-home residents

Catherine C Cohen  1 , Andrew W Dick  2 , Mansi Agarwal  3 , Tadeja Gracner  4 , Susan Mitchell  5 , Patricia W Stone  3
Affiliations

Trends in antibiotics use among long-term US nursing-home residents

Catherine C Cohen et al. Infect Control Hosp Epidemiol. 2021 Mar.

Abstract

Objectives: 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.

Design: Retrospective, repeated cross-sectional analysis.

Setting and participants: 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.

Measurements: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Conflicts of Interest:

The authors have no potential conflict of interest to report.

Figures

Figure 1.
Figure 1.
Proportion of Nursing Home Resident Assessments* with one-day antibiotic use, among all assessments, and those with ADRD, with and without ACI *Note: Minimum Data Set quarterly and annual assessments conducted from April 1st-November 30th, 2016, from a random 10% sample of CMS-certified U.S. nursing homes; “All” represents all resident assessments regardless of cognitive status; ACI, Advanced Cognitive Impairment; ADRD, Alzheimer’s Disease or Related Dementia. ** Significant change from 2012 to 2016, adjusted for seasonality
Figure 2.
Figure 2.
Proportion of Nursing Home Resident Assessments* with one-day antibiotic use among all assessments, those with common infectious diseases and those with no infectious diseases *Minimum Data Set quarterly and annual assessments, conducted from April 1st-November 30th, 2016, from a random 10% sample of CMS-certified U.S. nursing homes. ** Significant change from 2012 to 2016, adjusted for seasonality. NOTE: “All” represents all resident assessments regardless of infection status. UTI, urinary tract infection; MDRO, Multidrug-resistant infection.
See this image and copyright information in PMC

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