Antibiotic Stewardship in Nursing Homes
A recent study from the Journal of the American Geriatrics Society has examined the correlation between infections, antibiotic use, and confusion. It was found that 1 in 5 residents at the surveyed nursing homes had been prescribed antibiotics within the past 30 days, with urinary tract infections (UTI) accounting for 40 percent of antibiotic-treated infections within the 30-day period. In addition, a correlation was found between antibiotic treatment for UTIs and the subsequent development of confusion, fatigue, and restlessness.
Antibiotic use in nursing homes is something that needs to be handled with great care, as they have the potential to cause poor side effects. According to the CDC, antibiotics can be risky in nursing homes because nursing home residents often have a higher risk of bacteria colonization due to invasive devices such as catheters and feeding tubes, as well as a higher risk of bladder conditions. If the facility cannot properly differentiate between bacteria colonization and illness, this can cause an over-prescription of antibiotics, which can in turn increase antibiotic resistance. Along with other side effects, antibiotic use does carry a risk of a potentially fatal form of diarrhea caused by the pathogen C. difficile.
In spite of the dangerous side effects, it would not do to completely eschew the use of antibiotics in these facilities, as they can be beneficial in the case of certain infections, and infections can spread rapidly throughout the close quarters of a nursing home. However, though while up to 70 percent of nursing home residents (according to CDC figures) receive antibiotics in a one-year period, up to 75 percent of said antibiotics are incorrectly prescribed. Because of this, the CDC created The Core Elements of Antibiotic Stewardship for Nursing Homes, which are a set of guidelines and commitments that govern antibiotic use in order to ensure that patients receive the correct dosage of the correct antibiotics, and only in situations where they are absolutely necessary. The guidelines are as follows:
- Leadership commitment – Facility leaders, as well as leaders of regional and national locations if the facility is part of a larger corporation, should support antibiotic stewardship and set a strong example for the rest of their staff.
- Accountability – All nursing homes should establish who in their facility is accountable for antibiotic stewardship activities and provide them with the resources to make the program effective.
- Drug expertise – The facility, if they do not have someone fitting this description in their employ already, should have access to experts with experience and training in antibiotic use (such as pharmacists or infectious disease consultants).
- Take action through policy and practice change to improve antibiotic use – Actionable steps, particularly facility policy changes, should be taken to improve antibiotic use to reduce the risk of health hazards.
- Tracking and reporting antibiotic use and outcomes – If antibiotics are used, the facility should track their distribution and the outcome in order to assess their effectiveness. Data collected should be shared with healthcare providers in order to help the facility better understand the feedback and how they can adjust their program if need be.
- Education – The facility should provide resources to educate clinicians, nursing home staff, residents, and families on antibiotic stewardship.
Dr. Sean Mayne of James Cook University, the lead author of the study described at the beginning of this post, stated, “In the era of growing antimicrobial resistance, it is vital to ensure that antibiotics are only used when clearly indicated.” Regardless of the circumstance, antibiotics should always be distributed with caution in nursing homes in order to ensure the residents’ safety.
About Caitlin Morgan
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