Assessing Antibiotic Exposure Among Patients Admitted to VA Skilled Nursing Facility

Researchers found opportunities for intervention related to antibiotic use in a long-term care (LTC) facility with veteran patients, according to data published in The Senior Care Pharmacist.

As part of a quality improvement project, Brittany Tomlin, Community Living Center, Cincinnati VA Medical Center, Cincinnati, OH, and coresearchers examined antibiotic use among LTC residents admitted to the Community Living Center of a Midwestern VA medical center, a skilled nursing facility (SNF).

Patients admitted to the VA SNF between January 1, 2018, to December 31, 2018, who were prescribed an oral antibiotic (including via a percutaneous endoscopic gastronomy tube) were included in the evaluation. Patients admitted for hospice care, rehabilitation, short-term skilled nursing, or those on intravenous or topic antibiotics were excluded.

During the analysis period, researchers evaluated 56 unique courses of 13 different antibiotics with a median 39.7 days of therapy per 1000 resident days. The average days of antibiotic therapy was 7.6.

The most used antibiotics were fluroquinolones (26.8%) and beta-lactamase inhibitors (25%).

Researchers found 85.6% of the antibiotic courses to have appropriate dose and frequency, and 73.2% had appropriate duration.

Researchers said no reports of Clostridioides difficile infection were noted. Out of 56 total courses, 31 required cultures, of which 29 did not deescalate therapy. Of the 29, 17.2% (5) were indicated for de-escalation.

“Antibiotic use in this SNF have opportunities for intervention, including reducing fluoroquinolone use, optimizing de-escalation, and shortening days of therapy,” concluded researchers. “The implementation of an antimicrobial stewardship monitoring program within the LTC setting could assist in maximizing therapy while reducing antibiotic exposure.”

Reference:
Tomlin B, Philipp L, Potter B, Tate V. Evaluating antibiotic use in a Veterans Affairs skilled nursing facility. Sr Care Pharm. 2022;37(12):641-648. doi:10.4140/TCP.n.2022.641