Can Antibiotic Stewardship Programs Reduce Antibiotic Overuse in LTC Facilities?

Participation of long-term care (LTC) facilities in training on antibiotic stewardship from the Agency for Healthcare Research and Quality (AHRQ) correlated to a reduction in antibiotic use, according to a study published in JAMA Network Open.

“Developing, implementing, and sustaining antibiotic stewardship programs (ASPs) in LTC settings can be challenging due to frequent staff turnover and limited time and resources,” stated Morgan J Katz, MD, MHS, department of medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and colleagues.“Despite these challenges, the AHRQ Safety Program used patient-safety principles, multidisciplinary education, and a multitude of interactive tools aimed at incorporating stewardship principles into daily practice; high participation in the program was associated with a reduction in antibiotic use and improved outcomes.”

For this study, 439 of 523 LTC facilities in the United States met inclusion eligibility requirements and completed the safety program. Training took place between December 2018 and November 2019 and included 15 webinars.

Primary outcomes measured per 1000 resident-days included antibiotic starts, days of antibiotic therapy (DOT), the number of urine cultures, and Clostridioides difficile laboratory-identified events

“The mean difference for antibiotic starts from baseline to study completion per 1000 resident-days was -.41 (95% CI, -.76 to -.07; P = .02), with fluoroquinolones showing the greatest decrease at -.21 starts per 1000 resident-days (95% CI, -.35 to -.08; P = .002),” stated study authors. “The mean difference for antibiotic DOT per 1000 resident-days was not significant
(-3.05; 95% CI, -6.34 to .23; P = .07).”

Furthermore, study findings showed facilities with greater program engagement, measured by webinar attendance, had greater reductions in both antibiotic starts and usage.

“While antibiotic starts and DOT in these facilities decreased by 1.12 per 1000 resident-days (95% CI, -1.75 to -0.49; P < .001) and 9.97 per 1000 resident-days (95% CI, -15.4 to -4.6; P < .001), respectively, no significant reductions occurred in low engagement facilities,” stated researchers. “Urine cultures per 1000 resident-days decreased by 0.38 (95% CI, –0.61 to –0.15; P = .001).”

While reduction in antibiotic use and improved outcomes did occur, study authors concluded, “Data are needed to evaluate the sustainability of these interventions and their long-term effect on antibiotic use, resident outcomes, and staff and resident satisfaction.”

Reference:
Katz MJ, Tamma PD, Cosgrove SE, et al. Implementation of an antibiotic stewardship program in long-term care facilities across the US. JAMA Netw Open. 2022;5(2):e220181. doi:10.1001/jamanetworkopen.2022.0181.