Details

Autor(en) / Beteiligte

• Fridkin, Scott K
• Pack, Jacob
• Licitra, Giancarlo
• Zheng, Ziduo
• Watkins, Russell
• Price, Steve
• Camp, Mayfield
• Moore, Renee

Titel

Creating reasonable antibiograms for antibiotic stewardship programs in nursing homes: Analysis of 260 facilities in a large geographic region, 2016-2017

Ist Teil von

• Infection control and hospital epidemiology, 2019-08, Vol.40 (8), p.839-846

Ort / Verlag

United States: Cambridge University Press

Erscheinungsjahr

2019

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• To determine the best nursing home facility characteristics for aggregating antibiotic susceptibility testing results across nursing homes to produce a useful annual antibiogram that nursing homes can use in their antimicrobial stewardship programs. Derivation cohort study. Center for Medicare and Medicaid Services (CMS) certified skilled nursing facilities in Georgia (N = 231). All residents of eligible facilities submitting urine culture specimens for microbiologic testing at a regional referral laboratory. Crude and adjusted metrics of antibiotic resistance prevalence (percent of isolates testing susceptible) for 5 bacterial species commonly recovered from urine specimens were calculated using mixed linear models to determine which facility characteristics were predictive of testing antibiotic susceptibility. In a single year, most facilities had an insufficient number of isolates tested to create facility-specific antibiograms: 49% of facilities had sufficient Escherichia coli isolates tested, but only about 1 in 10 had sufficient isolates of Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, or Pseudomonas aeruginosa. After accounting for antibiotic tested and age of the patient, facility characteristics predictive of susceptibility were: E. coli, region, year, average length of stay; K. pneumoniae, region, bed size; P. mirabilis, region; and for E. faecalis or P. aerginosa no facility parameter remained in the model. Nursing homes often have insufficient data to create facility-specific antibiograms; aggregating data across nursing homes in a region is a statistically sound approach to overcoming data shortages in nursing home stewardship programs.