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Multicenter Study
. 2021 Apr 6;325(13):1286-1295.
doi: 10.1001/jama.2021.2900.

Antimicrobial Use in a Cohort of US Nursing Homes, 2017

Nicola D Thompson  1 , Nimalie D Stone  1 , Cedric J Brown  1 , Austin R Penna  1 , Taniece R Eure  1 , Wendy M Bamberg  2   3 , Grant R Barney  4   5 , Devra Barter  2 , Paula Clogher  6   7 , Malini B DeSilva  8   9 , Ghinwa Dumyati  4   10 , Linda Frank  11 , Christina B Felsen  4   10 , Deborah Godine  11 , Lourdes Irizarry  12 , Marion A Kainer  13   14 , Linda Li  15 , Ruth Lynfield  8 , J P Mahoehney  8 , Meghan Maloney  16 , Joelle Nadle  11 , Valerie L S Ocampo  17 , Rebecca Pierce  17 , Susan M Ray  18   19 , Sarah Shrum Davis  12 , Marla Sievers  12 , Krithika Srinivasan  6 , Lucy E Wilson  15   20 , Alexia Y Zhang  17 , Shelley S Magill  1
Affiliations
Multicenter Study

Antimicrobial Use in a Cohort of US Nursing Homes, 2017

Nicola D Thompson et al. JAMA. .

Abstract

Importance: Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited.

Objective: To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents.

Design, setting, and participants: Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website.

Exposures: Residence in one of the participating nursing homes at the time of the survey.

Main outcomes and measures: Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications.

Results: Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics.

Conclusions and relevance: In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bamberg reported receipt of grants to the institution from the Centers for Disease Control and Prevention (CDC) during the conduct of the study. Ms Barter reported grants from the CDC during the conduct of the study. Ms Clogher reported grants from the CDC during the conduct of the study. Dr DeSilva reported grants from the CDC Emerging Infections Program during the conduct of the study. Dr Dumyati reported grants from the CDC and personal fees from Roche Molecular Diagnostics Advisory network during the conduct of the study. Ms Frank reported grants from the CDC Emerging Infections Program cooperative agreement outside the submitted work. Dr Kainer reported grants (for funded staff) and nonfinancial support (for funded travel to Atlanta) from the CDC during the conduct of the study; nonfinancial support from the Council of State and Territorial Epidemiologists (CSTE) (travel support to attend CDC and CSTE meetings), the Society for Healthcare Epidemiology of America (SHEA) (travel support to SHEA as an invited speaker), and the Public Health Association of Australia (registration and travel support as keynote speaker for conference) outside the submitted work; and personal fees from Infectious Diseases Consulting Corpororation (board membership, compensation, travel support), WebMD (for creating continuing medical education ([CME] activity and travel support to create CME material in Atlanta), and Pfizer (honorarium and travel support to provide consultative advice on vaccine in phase 3 trials). Dr Lynfield reported grants from the CDC Emerging Infections Program cooperative agreement during the conduct of the study, and being coeditor of a book on preventive medicine and public health. Ms Maloney reported grants from the CDC Emerging Infections Program cooperative agreement during the conduct of the study and being a recipient of the 2019 Society for Healthcare Epidemiology of America Public Health Scholarship. Ms Nadle reported grants from the CDC Emerging Infections Program cooperative agreement outside the submitted work. Dr Pierce reported grants from the CDC Emerging Infections Program and CDC Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases during the conduct of the study, and personal fees from SHEA (committee member) outside the submitted work. Dr Wilson reported grants from Maryland Department of Health. The federal funding is for this research itself, from CDC to Maryland Department of Health:CDC-RFA-CK17-1701 - CDC Emerging Infections Program, "Healthcare Associated Infections and Community Interface", Infectious Diseases Epidemiology and Outbreak Response Bureau, Prevention and Health Promotion Administration, Maryland Department of Health, Baltimore, MD during the conduct of the study. Ms Zhang reported grants from Centers for Disease Control and Prevention during the conduct of the study. No other disclosures were reported.

Comment in

References

    1. World Health Organization . Fact sheet. Antimicrobial resistance. February 15, 2018. Accessed March 16, 2021. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
    1. Centers for Disease Control and Prevention . About TATFAR (Transatlantic Taskforce on Antimicrobial Resistance). Updated September 10, 2018. Accessed March 16, 2021. https://www.cdc.gov/drugresistance/tatfar/about.html
    1. D’Atri F, Arthur J, Blix HS, Hicks LA, Plachouras D, Monnet DL, European Survey on Transatlantic Task Force on Antimicrobial Resistance (TATFAR) Action Group . Targets for the reduction of antibiotic use in humans in the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) partner countries. Euro Surveill. 2019;24(28):1800339. doi:10.2807/1560-7917.ES.2019.24.28.1800339 - DOI - PMC - PubMed
    1. The White House. National Strategy for Combating Antibiotic-Resistant Bacteria. September 2014. Accessed March 16, 2021. https://obamawhitehouse.archives.gov/sites/default/files/docs/carb_natio...
    1. Centers for Disease Control and Prevention . US National Action Plan for Combating Antibiotic-Resistant Bacteria (National Action Plan). Published October 2020. Accessed March 16, 2021. https://www.cdc.gov/drugresistance/us-activities/national-action-plan.html

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