The CDC released new recommendations that are designed to reduce inappropriate prescribing practices and prevent the spread of antibiotic-resistant infections and C. difficile in nursing homes.
According to the CDC, up to 70% of nursing home residents receive one or more courses of antibiotics annually, and 75% percent of patients are either unnecessarily prescribed or are prescribed the wrong drug, dose, or duration.
In response, the CDC launched the “Core Elements of Antibiotic Stewardship for Nursing Homes.” The guidelines support the National Action Plan for Combating Antibiotic-resistant Bacteria and expand upon existing recommendations that all acute care hospitals implement an antibiotic stewardship program. They include utilizing financial and information technology resources, appointing leadership roles, monitoring prescriptions and resistance patterns, reporting antibiotic use and resistance to relevant staff, and educating clinicians about resistance and appropriate prescribing practices.
Based on the recommendations, appointed program leaders should support training and education in infectious diseases and/or antibiotic stewardship and ensure that staff members are given sufficient time to contribute to stewardship activities.
In addition, facilities should develop broad, pharmacy-driven, and infection- and syndrome- specific interventions based on each center’s needs. Broad interventions may incorporate antibiotic “time outs,” which prompt providers to reassess current treatment options 48 hours after treatment is initiated — a time when more diagnostic information is available. Pharmacy-driven interventions can include changes from intravenous to oral antibiotic therapies and dose adjustments based on drug monitoring.
Clinical outcomes that measure the impact of interventions should be monitored to improve antibiotic use. However, the CDC recommends against implementing too many interventions at one time.
“We encourage nursing homes to work in a step-wise manner implementing one or two activities at first, then gradually adding new strategies from each core element over time,” Nimalie Stone, MD, CDC medical epidemiologist for long-term care, said in a press release. “Taking any of these actions to improve antibiotic use in a nursing home will help protect against antibiotic-resistant infections and more effectively treat infections. This could lead to better recoveries from infections and ultimately improve health outcomes for all residents.”
Along with the current recommendations, the CDC will provide technical assistance to federal facilities and other large health care systems within the next 3 years to promote implementation of stewardship programs and to assess and share effective intervention outcomes. — by Stephanie Viguers