Antimicrobial Stewardship Program Reduces Antibiotic Use in LTC Residents with UTI

In a new study published in the journal Antimicrobial Resistance and Infection Control (2015;4:54), an antimicrobial stewardship program implemented in long-term care facilities effectively reduced unnecessary prescriptions of antibiotics to residents with urinary tract infection (UTI).

Antibiotics are often administered to older adults even when there is no evidence of clinical benefit. Antibiotic overuse can contribute to antimicrobial resistance, health complications such as asymptomatic bacteriuria, adverse drug events, and increased health care costs.

Residents in long-term care facilities frequently transition to and from the acute-care setting and can transport drug-resistant organisms across the continuum of care. This risk creates a need for increased antimicrobial stewardship programs. The Centers for Medicare and Medicaid Services (CMS) recommends that physicians prescribe appropriate antibiotics and establish the indication for use of these medications. They also recommend that consultant pharmacists review indications for antibiotic use and report their findings to the physician.

Sarah B. Doernberg and colleagues from the University of California, San Francisco, implemented antimicrobial stewardship programs targeting UTI over a 6-month period at three community long-term care facilities in order to increase compliance with the CMS recommendations. During the intervention, 104 antibiotic prescriptions for UTI were evaluated. Of the residents started on antibiotic medication for UTI, only 8 (8%) met the clinical criteria for antibiotic initiation. In 40 cases, recommendations were made for change in therapy, but the change was made in only 10 of these cases.

After initiation of the program, antibiotic prescriptions decreased by 26%, with an additional 6% decrease occurring over the course of the intervention period. Antibiotic prescriptions for any indication similarly decreased by 25% immediately after program initiation, with an additional 5% decrease occurring over the course of the program.

Although the study’s findings were modest, the authors did identify several areas in which the antimicrobial stewardship program could be improved, including more frequent review of residents on antibiotics and increased education and training of non-specialized care providers.—Kara Rosania