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Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities

Published online by Cambridge University Press:  10 May 2016

Jon P. Furuno ,
Angela C. Comer ,
J. Kristie Johnson ,
Joseph H. Rosenberg ,
Susan L. Moore ,
Thomas D. MacKenzie ,
Kendall K. Hall  and
Jon Mark Hirshon
Jon P. Furuno
Affiliation:
Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon
Angela C. Comer
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland National Study Center for Trauma and EMS, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Joseph H. Rosenberg
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Susan L. Moore
Affiliation:
Department of Patient Safety and Quality, Denver Health and Hospital Authority, Denver, Colorado; and Department of Medicine, University of Colorado Health Sciences Center, Denver Colorado
Thomas D. MacKenzie
Affiliation:
Department of Patient Safety and Quality, Denver Health and Hospital Authority, Denver, Colorado; and Department of Medicine, University of Colorado Health Sciences Center, Denver Colorado
Kendall K. Hall
Affiliation:
Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
Jon Mark Hirshon
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland National Study Center for Trauma and EMS, University of Maryland School of Medicine, Baltimore, Maryland Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Background.

Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.

Objective.

To develop SNF-specific antibiograms and identify opportunities to improve antibiotic prescribing.

Design and Setting.

Cross-sectional and pretest-posttest study among residents of 3 Maryland SNFs.

Methods.

Antibiograms were created using clinical culture data from a 6-month period in each SNF. We also used admission clinical culture data from the acute care facility primarily associated with each SNF for transferred residents. We manually collected all data from medical charts, and antibiograms were created using WHONET software. We then used a pretest-posttest study to evaluate the effectiveness of an antibiogram on changing antibiotic prescribing practices in a single SNF. Appropriate empirical antibiotic therapy was defined as an empirical antibiotic choice that sufficiently covered the infecting organism, considering antibiotic susceptibilities.

Results.

We reviewed 839 patient charts from SNF and acute care facilities. During the initial assessment period, 85% of initial antibiotic use in the SNFs was empirical, and thus only 15% of initial antibiotics were based on culture results. Fluoroquinolones were the most frequently used empirical antibiotics, accounting for 54.5% of initial prescribing instances. Among patients with available culture data, only 35% of empirical antibiotic prescribing was determined to be appropriate. In the single SNF in which we evaluated antibiogram effectiveness, prevalence of appropriate antibiotic prescribing increased from 32% to 45% after antibiogram implementation; however, this was not statistically significant (P = .32).

Conclusions.

Implementation of antibiograms may be effective in improving empirical antibiotic prescribing in SNFs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S56 - S61
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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