Nursing Home Antibiotic Stewardship Policy and Antibiotics Use: 2013-2017.
Nursing Home Antibiotic Stewardship Policy and Antibiotics Use: 2013-2017.
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DOI：
10.1016/j.jamda.2021.06.031
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发表时间：
2022-03
影响因子：
7.6
通讯作者：
Stone PW
中科院分区：
文献类型：
--
作者：
Agarwal M;Estrada LV;Gracner T;Dick AW;Stone PW
通过实施管理计划减少不适当的疗养院（NH）抗生素使用是国家的优先事项。我们的目的是评估抗生素管理计划对抗生素使用率的影响。回顾性、重复横断面分析。长期居民没有接受临终关怀在独立的NH参加了一个或两个调查在2013年和2017年。调查数据与最小数据集以及认证和调查提供商增强报告数据合并。我们的结果是抗生素使用的二元指标。主要预测因素是NH抗生素管理政策强度。使用多变量线性回归模型调整两年内不同的居民和设施特征，我们计算了2013年和2017年所有居民，阿尔茨海默病患者以及任何感染（包括尿路感染）的抗生素使用率。我们的样本包括2013年的317，003份居民评估和2017年的267，537份评估，分别居住在953和872个NH中。从2013年到2017年，NH抗生素管理政策强度增加（p < 0.01），在所有NH居民中，包括阿尔茨海默病患者，抗生素使用率下降（p < 0.05），其中45%的下降归因于加强管理计划。对于大多数居民来说，政策强度与尿路感染居民使用量的减少有关。然而，在患有UTI的阿尔茨海默病居民中，这种关联并不持久。虽然2017年抗生素使用有所减少，但需要更多时间才能看到抗生素管理政策的全面影响。调整直接解决实施障碍的计划和阿尔茨海默病患者适当使用UTI抗生素对于继续加强NH抗生素管理和改善护理是必要的。实施养老院抗生素管理计划是国家的优先事项，由于COVID-19、实施障碍和照顾弱势群体，可能需要进行调整。
Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship programs is a national priority. Our aim is to evaluate the influence of antibiotic stewardship programs on antibiotic use rates in NHs over time. Retrospective, repeated cross-sectional analysis. Long-term residents not receiving hospice care in freestanding NHs that participated in one or both surveys in 2013 and 2017. Survey data were merged with the Minimum Data Set and the Certification and Survey Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic use. The main predictor was the NH antibiotic stewardship policy intensity. Using multivariate linear regression models adjusting for resident and facility characteristics that differed between the two years, we calculated antibiotic use rates in 2013 and 2017 for all residents, those with Alzheimer’s disease, and those with any infection including urinary tract infections (UTIs). Our sample included 317,003 resident assessments from 2013 and 267,537 assessments from 2017, residing in 953 and 872 NHs, respectively. NH antibiotic stewardship policy intensity increased from 2013 to 2017 (p < 0.01) and among all NH residents, including those with Alzheimer’s disease, antibiotic use rate decreased (p < 0.05), with 45% of the decline attributable to strengthening stewardship programs. For most residents, policy intensity was associated with decreased usage in residents with UTI. However, among Alzheimer’s disease residents with a UTI, this association did not persist. While there was a decrease in antibiotic use in 2017, more time is needed to see the full impact of antibiotic stewardship policy into practice. Adjustments to programs that directly address barriers to implementation and appropriate UTI antibiotic use for residents with Alzheimer’s disease are necessary to continue strengthening NH antibiotic stewardship and improve care. Implementing nursing home antibiotic stewardship programs is a national priority and adjustments may be needed due to COVID-19, barriers to implementation, and for care of vulnerable populations.
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影响因子：
4.5
作者：
Seshadri, Sandhya;Felsen, Christina B.;Dumyati, Ghinwa K.
通讯作者：
Dumyati, Ghinwa K.
DOI：
10.15585/mmwr.mm6927e1
发表时间：
2020-07-10
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Sanchez GV;Biedron C;Fink LR;Hatfield KM;Polistico JMF;Meyer MP;Noe RS;Copen CE;Lyons AK;Gonzalez G;Kiama K;Lebednick M;Czander BK;Agbonze A;Surma AR;Sandhu A;Mika VH;Prentiss T;Zervos J;Dalal DA;Vasquez AM;Reddy SC;Jernigan J;Kilgore PE;Zervos MJ;Chopra T;Bezold CP;Rehman NK
通讯作者：
Rehman NK
影响因子：
4.9
作者：
Fu, Caroline J.;Mantell, Elise;Agarwal, Mansi
通讯作者：
Agarwal, Mansi
影响因子：
4.5
作者：
Fishman, Neil;Patterson, Jan;Newland, Jason
通讯作者：
Newland, Jason
DOI：
10.1177/0046958018778636
发表时间：
2018-05-28
影响因子：
1.7
作者：
Stone, Patricia W.;Herzig, Carolyn T. A.;Dick, Andrew W.
通讯作者：
Dick, Andrew W.