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Comparison of criteria for determining appropriateness of antibiotic prescribing in nursing homes

Published online by Cambridge University Press:  21 June 2021

Daniela Uribe-Cano Open the ORCID record for Daniela Uribe-Cano [Opens in a new window] ,
Mozhdeh Bahranian ,
Sally A. Jolles ,
Lindsay N. Taylor ,
Jill J. Miller ,
Sowmya N. Adibhatla  and
Christopher J. Crnich Open the ORCID record for Christopher J. Crnich [Opens in a new window]
Daniela Uribe-Cano
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Mozhdeh Bahranian
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Sally A. Jolles
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Lindsay N. Taylor
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Jill J. Miller
Affiliation:
University of Minnesota Medical School, Minneapolis, Minnesota
Sowmya N. Adibhatla
Affiliation:
Wisconsin Department of Health Services, Madison, Wisconsin
Christopher J. Crnich*
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
*
Author for correspondence: Christopher J. Crnich, E-mail: cjc@medicine.wisc.edu.
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Abstract

Background:

Measuring the appropriateness of antibiotic prescribing in nursing homes remains a challenge. The revised McGeer criteria, which are widely used to conduct infection surveillance in nursing homes, were not designed to assess antibiotic appropriateness. The Loeb criteria were explicitly designed for this purpose but are infrequently used outside investigational studies. The extent to which the revised McGeer and Loeb criteria overlap and can be used interchangeably for tracking antibiotic appropriateness in nursing homes remains insufficiently studied.

Methods:

We conducted a cross-sectional chart review study in 5 Wisconsin nursing homes and applied the revised McGeer and Loeb criteria to all nursing home–initiated antibiotic treatment courses. Kappa (κ) statistics were employed to assess level of agreement overall and by treatment indications.

Results:

Overall, 734 eligible antibiotic courses were initiated in participating nursing homes during the study period. Of 734 antibiotic courses, 372 (51%) satisfied the Loeb criteria, while only 211 (29%) of 734 satisfied the revised McGeer criteria. Only 169 (23%) of 734 antibiotic courses satisfied both criteria, and the overall level of agreement between them was fair (κ = 0.35). When stratified by infection type, levels of agreement between the revised McGeer and Loeb criteria were moderate for urinary tract infections (κ = 0.45), fair for skin and soft-tissue infections (0.36), and slight for respiratory tract infections (0.17).

Conclusions:

Agreement between the revised McGeer and Loeb criteria is limited, and nursing homes should employ the revised McGeer and Loeb criteria for their intended purposes. Studies to establish the best method for ongoing monitoring of antibiotic appropriateness in nursing homes are needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 860 - 863
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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