Utilizing Already Available Tools for Antimicrobial Stewardship Implementation in Post-Acute and ...

59 Pages·2017·7.28 MB·English

Utilizing Already Available Tools for
Antimicrobial Stewardship Implementation
in Post-Acute and Long-Term Care Facilities
Muhammad S. Ashraf, MBBS

Associate Professor,
Division of Infectious Diseases

Medical Director,
Nebraska Infection Control Assessment and Promotion Program

Co-Medical Director,
Nebraska Antimicrobial Stewardship Assessment and Promotion Program

University of Nebraska Medical Center
DISCLOSURES
•  Received grant funding for investigator initiated study from Merck & Co., Inc.,
OBJECTIVES
o  Understand why antimicrobial stewardship programs are
needed in long-term care facilities.
o  Learn various strategies to develop a formal antimicrobial
stewardship program in long-term-care facilities using
available resources.
o  Recognize the effectiveness and limitations of various
nursing home antimicrobial stewardship programs

LTCF Providing More Post-Acute Care Services

Post-acute care
(Medicare) admissions
are increasing in nursing
homes
–  Growing medical
complexity
–  Increasing exposure
to devices, wounds
and antibiotics
–  High prevalence of
multidrug-resistant
organisms
AHCA Quality Report 2013 AHCA Quality Report 2013
Reservoirs of MDROs
0.5
Both FQRB-only MRSA-only
0.4

)
%
(
0.3
d
e
z
i
n
o
l 0.2
o
C

n
o
i
t 0.1
r
o
p
o
r
P
0
1 2 3 4 5 6 Total
Facilities
Crnich et al. Infect Control Hospital Epidemiol 2012; 33(11):1172-4
Role in Regional Dissemination of MDROs
o  Outbreak of KPC-
producing
Enterobacteriaceae
studied over a period of
one year
o  42 cases were identified
o  24 cases were linked to 1
LTACH
o  75% of rest of the cases
were linked to 3 NH
o  Successful control
requires extensive
coordination between
acute and long term care
Won SY et al. Clin Infect Dis. 2011 Sep;53(6):532-40.
facilities
C. difficile Infections on the rise
C. difficile infections in US Nursing Homes
o  25 % to 75% of residents receive at least one course of
antibiotics.
o  8% to 33% of those treated with an antibiotic in a LTCF
acquire CDI.
o  Prevalence has been reported to be as high as 14 . 7 %
2000 2001 2002 2003 2004
o  Incidence has ranged from 0.2 to 2.6/1000 resident days in
some older studies
o  C. difficile estimated to have caused 112,800 infections with
onset in nursing homes in 2012 representing quarter of all
cases in the US.
Crnich CJ et al. Infect Control Hosp Epidemiol. 2007 Aug;28(8):1006-8
Hunter JC et al. Open Forum Infect Dis. 2016 Jan 18;3(1):ofv196.
Simor AE. J Am Geriatr Soc. 2010 Aug;58(8):1556-64
How big is the antibiotic problem in LTCF ?
Inappropriate Antibiotic Use in Nursing Homes
25 – 80% of use deemed
inappropriate:

–  Zimmer et al. J Am Geriatr Soc
1986; 34(10): 703-10
–  Katz et al. Arch Intern Med 1990;
150(7): 1465-8
–  Warren et al. J Am Geriatr Soc
1991; 39(10): 963-72
–  Pickering et al. J Am Geriatr Soc
1994; 42(1): 28-32
–  Loeb et al. J Gen Intern Med
2001; 16(6): 376-83
–  Vergidis et al. 2011; J Am Geriatr
Soc 59(6): 1093-8