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Factors Associated with Antimicrobial Use in Nursing Homes: A Multilevel Model

Authors

  • Stephen R. Benoit MD, MPH,

    1. From the *Division of Healthcare Quality PromotionImmunization Services Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.
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  • Wato Nsa MD, PhD,

    1. From the *Division of Healthcare Quality PromotionImmunization Services Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.
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  • Chesley L. Richards MD, MPH,

    1. From the *Division of Healthcare Quality PromotionImmunization Services Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.
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  • Dale W. Bratzler DO, MPH,

    1. From the *Division of Healthcare Quality PromotionImmunization Services Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.
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  • Abigail M. Shefer MD,

    1. From the *Division of Healthcare Quality PromotionImmunization Services Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.
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  • Lynn M. Steele MS,

    1. From the *Division of Healthcare Quality PromotionImmunization Services Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.
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  • John A. Jernigan MD, MS

    1. From the *Division of Healthcare Quality PromotionImmunization Services Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.
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  • Some of the data from this article were presented at the American College of Preventive Medicine Conference, Reno, Nevada, in February 2006.

Address correspondence to Stephen Benoit, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-51, Atlanta, GA 30033. E-mail: SBenoit@cdc.gov

Abstract

OBJECTIVES: To describe antimicrobial prescribing patterns in nursing homes.

DESIGN: Retrospective, observational study.

SETTING: Total of 73 nursing homes in four U.S. states; study period was from September 1, 2001, through February 28, 2002.

PARTICIPANTS: Four thousand seven hundred eighty nursing home residents.

MEASUREMENTS: Number and type of antimicrobials, indication for their use, and resident and facility factors associated with antimicrobial use in nursing homes.

RESULTS: Of 4,780 residents, 2,017 (42%) received one or more antibiotic courses. Overall, residents received a mean of 4.8 courses/1,000 resident-days (mean facility range 0.4–23.5). In multivariable analysis, higher probability of nursing home discharge and of being categorized in the rehabilitation, extensive services, special care, or clinically complex Resource Utilization Groups were associated with higher rates of antimicrobial usage. Three drug classes accounted for nearly 60% of antimicrobial courses—fluoroquinolones (38%), first-generation cephalosporins (11%), and macrolides (10%). The most common conditions for which antimicrobials were prescribed were respiratory tract (33%) and urinary tract (32%) infections.

CONCLUSION: Antibiotic use is variable in nursing homes. Targeting educational and other antimicrobial use interventions to the treatment of certain clinical diagnoses and conditions may be an appropriate strategy for optimizing antimicrobial use in this setting.

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