A study of US nursing homes found that two thirds of long-term residents were prescribed at least one antibiotic during their stay, researchers reported yesterday in the Journal of Infectious Diseases.
Using Medicare Part D claims data, researchers from the Brown University School of Public Health conducted a longitudinal, retrospective study of antibiotic use in Medicare beneficiaries who had spent at least 101 days in a nursing home (NH) from 2013 through 2017. They calculated period-prevalence estimates to assess any use of antibiotics during these long-stay NH episodes, along with the rate of antibiotic prescribing and antibiotic days of therapy (DOT).
Among 1,375,062 long-stay NH residents (67.3% female, 80.5% White), 66.2% were prescribed at least one antibiotic during their stay. Residents who received an antibiotic were slightly older (82.6 vs 81.9 years) and had longer stays (712.3 vs 451.7 days) than those who received no antibiotics.
The overall rate of antibiotic prescribing was 387 days per 1,000 person-years, and the rate of DOTs was 41.6 per 1,000 days of care. The most prevalent antibiotic classes were fluoroquinolones (36.2%), sulfonamides and related agents (16.2%), and first-generation cephalosporins (15.9%). Levofloxacin (22.1%), ciprofloxacin (19.4%), and trimethoprim-sulfamethoxazole (15.9%) were the most prevalent antibiotics.
The authors say the study overcomes some of the limitations of previous estimates of antibiotic use in US nursing facilities, most of which have relied on cross-sectional data and 1-day point-prevalence surveys.
"Our nationally representative results provide important foundational evidence on antibiotic prescribing in U.S. NHs and can inform future research, antibiotics stewardship initiatives, and policies to improve prescribing practices," the authors wrote.