Nursing home residents are using fewer antibiotics
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Key takeaways:
- Antibiotic use fell 28% in nursing homes over the course of a decade.
- CMS stewardship requirements in effect since 2017 have sped up the decline in antibiotic prescriptions.
SEATTLE — Antibiotic use in long-term care facilities declined significantly over the course of almost a decade, although there was an uptick in 2020 at the beginning of the COVID-19 pandemic, a study found.
According to findings presented at the Society for Healthcare Epidemiology of America Spring Conference, there was a 28% decline in antibiotic use in these facilities between 2013 and 2021, although Katryna Gouin, MPH, an epidemiologist at the CDC, and colleagues said they found room for improvement.
According to Gouin, about 50% to 70% of nursing home residents are prescribed an antibiotic each year, with 40% to 75% of these prescriptions being inappropriate.
CMS requires nursing homes to monitor their antibiotic use, and the CDC considers the tracking of these prescriptions a key component of antibiotic stewardship programs. However, some long-term care facilities struggle with this, according to Gouin.
“Monitoring antibiotic use can identify opportunities for improvement and guide practice changes,” Gouin said during a presentation. “However, most nursing homes do not have ready access to resources that are necessary to track and report on their antibiotic use, and unlike in acute-care hospitals, there are no national data to track antibiotic use in these settings.”
Gouin and colleagues estimated annual antibiotic use rates using prescription dispenses and resident census data from PharMerica, which provides services to about 20% of long-term care facilities in the United States.
They analyzed data collected between 2013 and 2021 on facilities with more than 4 months of antibiotic dispensing and 12 months of census data, calculating course duration as the difference between end and dispense dates. Using these data, they reported yearly antibiotic use as courses per 1,000 residents and days of therapy per 1,000 resident-days.
Over the course of the entire 9-year period, antibiotic courses per 1,000 residents decreased by 28% and antibiotic days of therapy per 1,000 resident-days decreased by 13%. Although both had been slowly declining, researchers found the declines started to speed up in 2017, when CMS stewardship requirements in nursing homes went into effect.
There was a roughly 3% uptick in antibiotic prescriptions from the start of the COVID-19 pandemic in March 2020, which continued until the rollout of COVID-19 vaccines in nursing homes in December 2020, when the decrease in prescriptions resumed. In their abstract, the researchers said the increase in 2020 “could be secondary to changes in prescribing practices and resident population” during the pandemic.
During the study period, although days of therapy, number of courses and percent of residents prescribed an antibiotic per year decreased by 9% from 2013 to 2021, median antibiotic course duration stayed unchanged at 7 days.
According to the study, these declines were driven mostly by decreases in fluoroquinolone (10%) and macrolide (2%) antibiotic courses. The researchers also noted that increases in prescriptions for cephalosporins (7%) and tetracyclines (5%) were observed during the study period.
The researchers found prescription rates decreased in more recent years with shifts in the class of antibiotics being used, as well as because of the CMS requirements and adverse event warnings from both the CMS and the FDA.
Gouin noted several opportunities to improve antibiotic prescribing in long-term care facilities, highlighting that treatment optimization should be a focus because course durations stayed the same over the course of the 9-year study period.
She also said that facilities should draw on long-term pharmacy resources to provide stewardship expertise and experience, while also helping to support prescription tracking and data interpretation — and increasing automation to do so.
“Automated tracking and reporting in long-term care facilities will reduce burden on staff and can support benchmarking antibiotic use in long-term care facilities, which is not currently available and could greatly improve the future of antibiotic stewardship,” Gouin said.
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Gouin K, et al. Changes in U.S. long-term care facility antibiotic prescribing, 2013-2021. Presented at: Society for Healthcare Epidemiology of America Spring Conference; April 11-14, 2023; Seattle.
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