Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility.

Autor: Davenport C; Icahn School of Medicine at Mount Sinai, Albany, New York., Brodeur M; Albany College of Pharmacy and Health Sciences, Albany, New York., Wolff M; Albany Medical College, Albany, New York.; The Eddy Foundation, St. Peter's Health Partners, Albany, New York., Meek PD; Albany College of Pharmacy and Health Sciences, Albany, New York., Crnich CJ; School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.; William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2020 Jan; Vol. 68 (1), pp. 55-61. Date of Electronic Publication: 2019 Aug 29.
DOI: 10.1111/jgs.16134
Abstrakt: 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.
(© 2019 The American Geriatrics Society.)
Databáze: MEDLINE
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