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Background Antibiotics are frequently prescribed among senior living residents, with the over diagnosis of infections playing a significant problem. Elderly are vulnerable to the harms of inappropriate antibiotic use. Methods We evaluated the use of systemic antibiotics, the diagnosis of facility-onset urinary tract infection (based on McGeer’s criteria), and C. difficile infections in the 4 large (>250 resident beds) Senior Living Centers in 4 different states. All measures were normalized per 1,000 resident-days and evaluated over 9 months between July 2015 and March 2016. In addition, we visited the 4 facilities and qualitatively evaluated factors that may influence antibiotic use. Results There were 27,255 antibiotic-days at a rate of 106.8 per 1,000 resident-days. Non-quinolone antiurinary agents accounted for 22.3 (20.9%), quinolones for 21.5 (20.2%), cephalosporins 16.8 (15.7%), penicillins 8.0 (7.5%), and tetracyclines 8.2 (7.7%), and macrolides 6.31 (5.9%) antibiotic-days per 1,000 resident-days. There were marked differences in the use of urinary antimicrobials between the 4 facilities (Figure 1). Facility A and B had more than 6 times antibiotic use compared with facility D, and had the highest rates for UTI (Table 1). Clostridium difficile infections were highest in facility A compared with other facilities. The two facilities lowest antimicrobial use had strong physician-nursing partnership with engaged medical directors. Conclusion Considerable opportunities reside in Senior Living to optimize testing and appropriate antibiotic use. Engaging both nurses and physicians, in addition to regular evaluation of use with feedback are key to standardizing the care and improving the outcomes. Table 1: Antimicrobial Use, Urinary Tract Infections, and Clostridium difficile Infections at the 4 Facilities. Facility A Facility B Facility C Facility D P-value Antibiotic-Days 11,087 9,439 5,109 1,620 Urinary Tract Infections 106 143 31 32 Clostridium difficile Infections 16 4 6 0 Resident-Days 63,906 57,871 67,007 66,411 Antibiotic Days per 1,000 Resident-Days 173.5 163.1 76.3 24.4 <0.001 UTIs per 1,000 Resident-Days 1.66 2.47 0.46 0.48 <0.001 C. difficile per 1,000 Resident-days 0.25 0.07 0.09 0 0.001Figure 1 Nitrofurantoin, TMP/Sulfa and Quinolone Rates for the 4 Facilities. Disclosures All authors: No reported disclosures.

Protecting Our Most Vulnerable: Why Antimicrobial Stewardship for Senior Living Is a Must: Results from Four Large Senior Living Centers