Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T14:00:49.289Z Has data issue: false hasContentIssue false
  • English
  • Français

Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long-Term–Care Facilities: Results of a Consensus Conference

Published online by Cambridge University Press:  02 January 2015

Mark Loeb ,
David W. Bentley ,
Suzanne Bradley ,
Kent Crossley ,
Richard Garibaldi ,
Nelson Gantz ,
Allison McGeer ,
Robert R. Muder ,
Joseph Mylotte  and
Lindsay E. Nicolle
...Show all authors
Mark Loeb*
Affiliation:
Division of Infectious Diseases and Medical Microbiology, McMaster University and Hamilton Civic Hospitals, Hamilton, Ontario, Canada
David W. Bentley
Affiliation:
Department of Internal Medicine, Saint Louis University School of Medicine, Geriatric Research, Education and Clinical Center, St Louis Veterans Affairs (VA) Medical Center, St Louis, Missouri
Suzanne Bradley
Affiliation:
VA Medical Center GRECC, Ann Arbor, Michigan
Kent Crossley
Affiliation:
Education Service, VA Medical Center, Minneapolis, Minnesota
Richard Garibaldi
Affiliation:
Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut
Nelson Gantz
Affiliation:
Department of Medicine, Polyclinic Medical Center, Harrisburg, Pennsylvania
Allison McGeer
Affiliation:
Department of Infection Control, Mount Sinai Hospital and theUniversity of Toronto, Toronto, Ontario, Canada
Robert R. Muder
Affiliation:
VA Pittsburgh Healthcare System, University of Pittsburgh Medical Center, Pennsylvania
Joseph Mylotte
Affiliation:
Erie County Medical Center, Buffalo, New York
Lindsay E. Nicolle
Affiliation:
Department of Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
Brenda Nurse
Affiliation:
Hospital for Special Care, New Britain, Connecticut
Shirley Paton
Affiliation:
Laboratory Centre for Disease Prevention and Control, Health Canada, Ottawa, Ontario, Canada
Andrew E. Simor
Affiliation:
Sunnybrook and Women's College Health Sciences Center and theUniversity of Toronto, Toronto, Ontario, Canada
Philip Smith
Affiliation:
University of Nebraska Medical Center, Omaha, Nebraska
Larry Strausbaugh
Affiliation:
Portland VA Medical Center, Portland, Oregon
*
Hamilton Health Sciences Corp, Henderson General Hospital Site, 711 Concession St, Hamilton, ON L8V 1C3, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Establishing a clinical diagnosis of infection in residents of long-term–care facilities (LTCFs) is difficult. As a result, deciding when to initiate antibiotics can be particularly challenging. This article describes the establishment of minimum criteria for the initiation of antibiotics in residents of LTCFs. Experts in this area were invited to participate in a consensus conference. Using a modified delphi approach, a questionnaire and selected relevant articles were sent to participants who were asked to rank individual signs and symptoms with respect to their relative importance. Using the results of the weighting by participants, a modification of the nominal group process was used to achieve consensus. Criteria for initiating antibiotics for skin and soft-tissue infections, respiratory infections, urinary infections, and fever where the focus of infection is unknown were developed.

Type
Topics in Long-Term Care
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 2 , February 2001 , pp. 120 - 124
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Mylotte, JM. Antimicrobial prescribing in long-term care facilities: prospective evaluation of potential antimicrobial use and cost indicators. Am J Infect Control 1999;27:10–19.Google Scholar
2. Montgomery, P, Semenchuk, M, Nicolle, LE. Antimicrobial use in nursing homes in Manitoba. Journal of Geriatric Drug Therapy 1995;9:55–74.CrossRefGoogle Scholar
3. Warren, JW, Palumbo, FB, Fitterman, L, Speedie, SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39:963–972.Google Scholar
4. Katz, PR, Beam, TR Jr Brand, F, Boyce, K. Antibiotic use in the nursing home. Physician practice patterns. Arch Intern Med 1990;150:1465–1468.Google Scholar
5. Smith, PW. Nursing home infection control: a status report. Infect Control Hosp Epidemiol 1998;19:366–369.CrossRefGoogle ScholarPubMed
6. Armstrong-Evans, M, Lift, M, McArthur, MA, Willey, B, Cann, D, Liska, S, et al. Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term–care facility. Infect Control Hosp Epidemiol 1999;20:312–317.Google Scholar
7. Greenaway, CA, Miller, MA. Lack of transmission of vancomycin-resistant enterococci in three long-term–care facilities. Infect Control Hosp Epidemiol 1999;20:341–343.Google Scholar
8. Wiener, J, Quinn, JP, Bradford, PA, Goering, RV, Nathan, C, Bush, K, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.Google Scholar
9. Terpenning, MS, Bradley, SF, Yan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA. Colonization and infection with antibiotic-resistant bacteria in a long-term care facility. J Am Geriatr Soc 1994;42:1062–1069.Google Scholar
10. Wingard, E, Shlaes, JH, Mortimer, EA, Shlaes, DM. Colonization and cross-colonization of nursing home patients with trimethoprim-resistant gram-negative bacilli. Clin Infect Dis 1993;16:75–81.Google Scholar
11. Chenoweth, CE, Bradley, SF, Terpenning, MS, Zarins, LT, Ramsey, MA, Schaberg, DR, et al. Colonization and transmission of high-level gentamicin-resistant enterococci in a long-term care facility. J Am Geriatr Soc 1994;15:703–709.Google Scholar
12. Gaynes, RP, Weinstein, RA, Chamberlin, W, Kabins, SA. Antibiotic-resistant flora in nursing home patients admitted to the hospital. Arch Intern Med 1985;145:1804–1807.Google Scholar
13. Rice, LB, Willey, SH, Papanicolaou, GA, Medeiros, AA, Eliopoulos, GM, Moellering, RC Jr et al. Outbreak of ceftazidime resistance caused by extended-spectrum β-lactamases at a Massachusetts chronic care facility. Antimicrob Agents Chemother 1990;34:2193–2199.Google Scholar
14. Muder, RR, Brennen, C, Goetz, AM, Wagener, MM, Rihs, JD. Association with prior fluoroquinolone therapy of widespread ciprofloxacin resistance among gram-negative isolates in a Veterans Affairs medical center. Antimicrob Agents Chemother 1991;35:256–258.Google Scholar
15. Nicolle, LE, Bentley, D, Garibaldi, R, Neuhaus, E, Smith, P, SHEA Long-Term Care Committee. Antimicrobial use in long-term care facilities. Infect Control Hosp Epidemiol 1996;17:119–128.Google Scholar
16. Nicolle, LE, Strausbaugh, LJ, Garibaldi, RA. Infections and antibiotic resistance in long-term care facilities. Clin Microbiol Rev 1996;9:1–17.Google Scholar
17. Strausbaugh, LJ, Joseph, C. Epidemiology and prevention of infections in residents of long-term care facilities. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams and Wilkins;1996:1151–1170.Google Scholar
18. Zimmer, JG, Bentley, DW, Valenti, WM, Watson, NM. Systemic antibiotic use in nursing homes. J Am Geriatr Soc 1986;34:703–710.CrossRefGoogle ScholarPubMed
19. Jones, SR, Parker, DF, Liebow, ES, Kimbrough, RC, Frear, RS. Appropriateness of antibiotic therapy in long-term care facilities. Am J Med 1987;83:499–502.Google Scholar
20. Metlay, JP, Kapoor, WN, Fine, MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA 1997;278:1440–1445.Google Scholar
21. Wipf, JE, Lipsky, BA, Hirschmann, JV, Boyko, EJ, Takasugi, J, Peugeot, RL, et al. Diagnosing pneumonia by physical examination: relevant or relic? Arch Intern Med 1999;159:1082–1087.Google Scholar
22. McGeer, A, Campbell, B, Emori, TG, Hierholzer, WJ, Jackson, MM, Nicolle, LE, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991;19:1–7.Google Scholar
23. Jones, J, Hunter, D. Consensus methods for medical and health services research. BMJ 1995;311:376–380.Google Scholar
24. Orr, PH, Peeling, RW, Fast, M, Brunka, J, Duckworth, H, Harding, GK, et al. Serological study of responses to selected pathogens causing respiratory tract infection in the institutionalized elderly. Clin Infect Dis 1996;23:1240–1245.Google Scholar
25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000. Text Revision.Google Scholar
26. Ball, P, Chodosh, S, Grossman, R, Tillotson, M, Wilson, R. Causes, epidemiology, and treatment of bronchial infections. Infect Med. 2000;17:186–189.Google Scholar
27. Wasserman, M, Levinstein, M, Keller, E, Lee, S, Yoshikawa, TT. Utility of fever, white blood cells, and differential count in predicting bacterial infections in the elderly. J Am Geriatr Soc 1989;37:537–543.Google Scholar
28. Nicolle, LE. Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am 1997;11:647–662.CrossRefGoogle ScholarPubMed
29. Nicolle, LE, Bjornson, J, Harding, GK, MacDonnell, JA. Bacteriuria in elderly institutionalized men. N Engl J Med 1983;309:1420–1425.Google Scholar
30. Nicolle, LE, Mayhew, JW, Bryan, L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized women. Am J Med 1987;83:27–33.Google Scholar
31. Ouslander, JG, Schapira, M, Schnelle, JF, Uman, G, Fingold, S, Tuico, E, et al. Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med 1995;122:749–754.Google Scholar
32. Abrutyn, E, Mossey, J, Berlin, JA, Boscia, J, Levison, M, Pitsakis, P, et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women. Ann Intern Med 1994;120:827–833.Google Scholar
33. Cookson, BD. The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998;41:11–18.Google Scholar