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Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility
Author(s) -
Davenport Claire,
Brodeur Michael,
Wolff Michael,
Meek Patrick D.,
Crnich Christopher J.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16134
Subject(s) - medicine , cefazolin , proteus mirabilis , antibiotics , antibiotic stewardship , sulfamethoxazole , antibiotic resistance , microbiology and biotechnology , staphylococcus aureus , biology , bacteria , genetics
OBJECTIVES To derive weighted‐incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use. DESIGN Retrospective analysis of microbial data from a regional laboratory. SETTING We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015. PARTICIPANTS A total of 28 regional SNFs (rSNFs) and 7 in‐network SNFs (iSNFs). MEASUREMENTS WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae , and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole. RESULTS Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11‐113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76‐11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I 2 = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols. CONCLUSION These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55–61, 2019