An analysis of Minimum Data Set assessments has found that overall antibiotic use in nursing homes did not change from 2012 to 2016, and that there was an increase in use where no infection was reported.
Investigators examined data for more than 300,000 residents in a random national sample of 1,562 nursing homes. They calculated one-day antibiotic prevalence using all annual and quarterly clinical assessments in the MDS during the study period.
Despite national campaigns to reduce inappropriate prescribing in long-term care, there was no change in overall antibiotic use, the researchers found. And use was higher in 2016 versus 2012 among assessments with any infection, urinary tract infection, and no infection, they reported. The results were similar among residents with Alzheimer’s disease and related dementias and in those with advanced cognitive impairment.
Although the researchers could not use the data to directly determine whether the antibiotic use was appropriate in each case, the adjusted results suggest that it may be time to refocus stewardship in nursing homes, concluded lead investigator Catherine C. Cohen, Ph.D., RN., of the Columbia University School of Nursing, New York.
“The increased proportion of assessments recording antibiotics but no infection may not be clinically appropriate,” said Cohen. “Higher antibiotic use among infected residents with advanced cognitive impairment is also concerning,” she added. “Further efforts to understand mechanisms driving these trends and to promote antibiotic stewardship in nursing homes are warranted.”
Full findings were published in Infection Control & Hospital Epidemiology.
