Antibiotics Overused in Nursing Homes, Study Shows

A new study suggests antibiotics are likely being overused in some nursing homes and reports a link between this practice and a higher risk of adverse outcomes for all residents in these facilities.

“Unlike other medication classes which can harm the individual recipient of that medication, antibiotics have the capacity to do harm even beyond the individual that gets the medication,” said first author of the study Nick Daneman, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Adverse outcomes associated with inappropriate antibiotic use include Clostridium difficile infection, diarrhea or gastroenteritis, antibiotic-resistant organisms, allergic reactions, and adverse events associated with taking the antibiotic medication.

To examine whether living in a nursing home with high antibiotic use is associated with an increased risk of antibiotic-related adverse outcomes for individual residents, the researchers carried out a longitudinal open-cohort study from January 1, 2010, through December 31, 2011. In total, 110,656 older adults residing in 607 nursing homes in Ontario, Canada, were included in the study. Nursing homes were classified according to their level of antibiotic use, taking into account the number of residents in the facility and the number of days included in the study period. Multivariable logistic regression modeling was then used to evaluate the relationship between the level of antibiotic use – high, medium, or low – and the individual risk of antibiotic-related adverse outcomes.

Antibiotic use was found to be highly variable across the nursing homes studied, ranging from 20.4 to 192.9 antibiotic-days per 1000 resident-days. Antibiotic-related adverse events were significantly more common in residents of high-antibiotic-use facilities (13.3%) than in residents of medium-antibiotic-use facilities (12.4%) or low-antibiotic-use facilities (11.4%), even among the residents who did not receive antibiotic treatments. Further analyses showed a significant association between residence in a high-antibiotic-use nursing home and an increased risk of a resident experiencing an antibiotic-related adverse event (https://bit.ly/1Juifqc).

Because misuse of antibiotics has the potential to adversely affect not only the individual taking the medication but also other individuals within the same environment, the inappropriate prescribing of these medications is particularly a concern in nursing homes. The study’s authors suggest that antibiotic stewardship is needed to improve the safety of all nursing home residents. — Kara Rosania