Stewardship Programs in Nursing Homes Reduce Antibiotic Misuse, Resistance

Antimicrobial stewardship programs are recommended interventions to improve antimicrobial use and combat the growing threat of antimicrobial resistance.

Antimicrobial stewardship program (ASPs) in nursing homes decrease antimicrobial use and multidrug-resistant organisms without causing an increase in hospitalizations due to infection, according to study results published in Clinical Infectious Disease.

Researchers conducted a parallel-group, randomized controlled trial with a before-after study from July 1, 2018, to December 31, 2020, to determine the clinical and ecological impact of an antimicrobial stewardship program for nursing homes. A time-series analysis was performed in 14 nursing homes in Andalusia, Spain, in which 7 of these nursing homes utilized an ASP that focused on the clinical and ecological impact of antibiotic overuse and misuse. The control group comprised 7 nursing homes. There were 100 residents and 114 beds within the ASP group, and 99 participants and 110 beds within the control group.

The researchers performed a linear mixed-effects model regression with random intercepts to analyze the intervention’s effect on antimicrobial prescriptions. Pearson correlation was used to analyze the relationship between antimicrobial use and multidrug-resistant organisms (MDRO). The primary outcome was to evaluate antimicrobial use as defined by daily dose per 1000 residents (DRD). Secondary outcomes included measuring the rates of MDRO, the antimicrobial prescribing profile, and hospital admissions caused by infection.

This study suggests that an antimicrobial stewardship program for nursing homes appears to be associated with a decrease in total consumption of antimicrobials and prevalence of multidrug-resistant organisms.

The total mean antimicrobial use decreased by 31.2% (DRD, -16.72; P =0.045) compared with antimicrobial use before the ASP. The rates of MDRO decreased from 24.7 to 17.4% (P =0.012). The nursing homes reduced their use of quinolones by 52.5 % (P =0.001) and amoxicillin-clavulanate by 42.5% (P= 0.006). There was no change in the mean consumption of other antibiotics. The ASP minimized the all-center mean total antimicrobial use by 31.2% (DRD, -16.2%; P =0.045). At the beginning of the program, 1 in 4 nursing home residents were infected with an MDRO. At the end of the program, 1 in 6 nursing home residents were infected, indicating a decrease of 7.3% (P =0.012).

Limitations of the study include a limited number of clusters in the study and the onset of the COVID-19 pandemic and the associated increase in hand hygiene, mask wearing, and contact precautions.

The study authors conclude, “This study suggests that an antimicrobial stewardship program for nursing homes appears to be associated with a decrease in total consumption of antimicrobials and prevalence of multidrug-resistant organisms.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

References:

Peñalva G, Crespo-Rivas JC, Guisado-Gil AB, et al. Clinical and ecological impact of an educational program to optimize antibiotic treatments in nursing homes (PROA-senior): A cluster, randomized, controlled trial and interrupted time-series analysis. Clin Infect Dis. 2022. doi:10.1093/cid/ciac834