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Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

  • Bo R. Weber (a1) (a2), Brie N. Noble (a1), David T. Bearden (a1) (a2), Christopher J. Crnich (a3) (a4), Katherine D. Ellingson (a5), Jessina C. McGregor (a1) and Jon P. Furuno (a1)...



To quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).


Retrospective cohort study.


A 576-bed, academic hospital in Portland, Oregon.


Adult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.


Our primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.


Among 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).


Antibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.


Corresponding author

Author for correspondence: Jon P. Furuno, Oregon State University, Oregon Health & Science University College of Pharmacy, Department of Pharmacy Practice, 2730 SW Moody Ave, Mail Code: CL5CP, Portland, OR 97201. E-mail:


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PREVIOUS PRESENTATION: These data were presented in part at the 2016 American Society of Health-System Pharmacists Midyear Clinical Meeting and Exposition on December 6, 2016, in Las Vegas, Nevada, and at the 2017 American Society of Health-System Pharmacists Midyear Clinical Meeting and Exposition on December 5, 2017, in Orlando, Florida.

Cite this article: Weber Bo R. (2019). Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings. Infection Control & Hospital Epidemiology 2019, 40, 18–23. doi: 10.1017/ice.2018.288



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1. Morrill, HJ, Caffrey, AR, Jump, RL, et al. Antimicrobial stewardship in long-term care facilities: a call to action. J Am Med Dir Assoc 2016;17:183 e116. doi: 10.1016/j.jamda.2015.11.013.
2. Nicolle, LE, Bentley, DW, Garibaldi, R, et al. Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee. Infect Control Hosp Epidemiol 2000;21:537545.
3. Brown, KA, Jones, M, Daneman, N, et al. Importation, antibiotics, and Clostridium difficile infection in veteran long-term care: a multilevel case-control study. Ann Intern Med 2016;164:787794.
4. Daneman, N, Gruneir, A, Bronskill, SE, et al. Prolonged antibiotic treatment in long-term care: role of the prescriber. JAMA Intern Med 2013;173:673682.
5. Laffan, AM, Bellantoni, MF, Greenough, WB 3rd, et al. Burden of Clostridium difficile-associated diarrhea in a long-term care facility. J Am Geriatr Soc 2006;54:10681073.
6. Pawar, D, Tsay, R, Nelson, DS, et al. Burden of Clostridium difficile infection in long-term care facilities in Monroe County, New York. Infect Control Hosp Epidemiol 2012;33:11071112.
7. Stone, ND, Lewis, DR, Johnson, TM 2nd, et al. Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in residents of Veterans Affairs long-term care facilities: role of antimicrobial exposure and MRSA acquisition. Infect Control Hosp Epidemiol 2012;33:551557.
8. van Buul, LW, van der Steen, JT, Veenhuizen, RB, et al. Antibiotic use and resistance in long-term care facilities. J Am Med Dir Assoc 2012;13:568 e561513.
9. Medicare and Medicaid Programs; Reform of requirements for long-term care facilities. Federal Register website. Published 2016. Accessed May 22, 2018.
10. Burke, RE, Whitfield, EA, Hittle, D, et al. Hospital readmission from post-acute care facilities: risk factors, timing, and outcomes. J Am Med Dir Assoc 2016;17:249255.
11. US Department of Health and Human Services. Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. Published 2014.
12. Ouslander, JG, Lamb, G, Perloe, M, et al. Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs. J Am Geriatr Soc 2010;58:627635.
13. Lapane, KL, Dube, CE, Pakyz, AL. Entangled practices, entangled epidemics: antibiotic practices and healthcare associated infections in nursing homes and hospitals. J Nursing Home Res 2016;2:2126.
14. Carter, RR, Montpetite, MM, Jump, RLP. Mixed-methods pilot study to assess perceptions of antimicrobial stewardship in nursing homes. J Am Geriatr Soc 2017;65:10731078.
15. Davey, P, Marwick, CA, Scott, CL, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017;2:CD003543.
16. Dizon, ML, Zaltsmann, R, Reinking, C. Partnerships in transitions: acute care to skilled nursing facility. Prof Case Manag 2017;22:163173.
17. Fleming, A, Bradley, C, Cullinan, S, et al. Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation. BMJ Open 2014;4:e006442. doi: 10.1136/bmjopen-2014-006442.
18. Petigara, S, Krishnamurthy, M, Livert, D. Necessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities. J Community Hosp Intern Med Perspect 2017;7:6669.
19. Vasilevskis, EE, Ouslander, JG, Mixon, AS, et al. Potentially avoidable readmissions of patients discharged to post-acute care: perspectives of hospital and skilled nursing facility staff. J Am Geriatr Soc 2017;65:269276.
20. Furuno, JP, Noble, BN, Horne, KN, et al. Frequency of outpatient antibiotic prescription on discharge to hospice care. Antimicrob Agents Chemother 2014;58:54735477.
21. Kowalewska, CA, Noble, BN, Fromme, EK, et al. Prevalence and clinical intentions of antithrombotic therapy on discharge to hospice care. J Palliat Med 2017;20:12251230.
22. Servid, SA, Noble, BN, Fromme, EK, et al. Clinical intentions of antibiotics prescribed upon discharge to hospice care. J Am Geriatr Soc 2018;66:565569.
23. Richards, CL Jr, Darradji, M, Weinberg, A, et al. Antimicrobial use in post-acute care: a retrospective descriptive analysis in seven long-term care facilities in Georgia. J Am Med Dir Assoc 2005;6:109112.
24. Scarpato, SJ, Timko, DR, Cluzet, VC, et al. An evaluation of antibiotic prescribing practices upon hospital discharge. Infect Control Hosp Epidemiol 2017;38:353355.
25. Kwan, JL, Lo, L, Sampson, M, et al. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Ann Intern Med 2013;158:397403.
26. Mor, V, Intrator, O, Feng, Z, et al. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood) 2010;29:5764.
27. Finucane, TE. Urinary tract infection—requiem for a heavyweight. J Am Geriatr Soc 2017;65:16501655.
28. Emerson, CB, Eyzaguirre, LM, Albrecht, JS, et al. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012;33:539544.


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