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Effective Antimicrobial Stewardship in a Long-Term Care Facility through an Infectious Disease Consultation Service: Keeping a LID on Antibiotic Use

Published online by Cambridge University Press:  02 January 2015

Robin L. P. Jump*
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Danielle M. Olds
Affiliation:
National Quality Scholars Program, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Nasim Seifi
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Georgios Kypriotakis
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Lucy A. Jury
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Emily P. Peron
Affiliation:
Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
Amy A. Hirsch
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Pharmacy Services, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
Paul E. Drawz
Affiliation:
Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Brook Watts
Affiliation:
Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Departments of Pathology, Pharmacology, and Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Curtis J. Donskey
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
*
GRECC 111C(W), Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106 (robinjump@gmail.com)

Abstract

Design.

We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.

Setting.

A 160-bed VA LTCF.

Methods.

Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.

Results.

Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P = .008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P = .04).

Conclusions.

Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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