Effective Antimicrobial Stewardship in a Long-term Care Facility Through an Infectious Disease Consultation Service: Keeping a LID on Antibiotic Use

Overview

Journal Infect Control Hosp Epidemiol

Publisher Cambridge University Press

Specialties Health Services
Infectious Diseases
Nursing
Public Health

Date 2012 Nov 13

PMID 23143354

Citations 56

Authors

Robin L P Jump

Danielle M Olds

Nasim Seifi

Georgios Kypriotakis

Lucy A Jury

Emily P Peron

Amy A Hirsch

Paul E Drawz

Brook Watts

Robert A Bonomo

Curtis J Donskey

Affiliations

Soon will be listed here.

Abstract

Design: We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.

Setting: A 160-bed VA LTCF.

Methods: Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.

Results: Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P=.008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β-lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P=.04).

Conclusions: Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.

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