Skip to main content

Advertisement

SpringerLink
Log in

Antibiotic use in ontario facilities that provide chronic care

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

OBJECTIVE: To determine the incidence and variability of antibiotic use in facilities which provide chronic care and to determine how often clinical criteria for infection are met when antibiotics are prescribed in these facilities.

DESIGN: A prospective, 12-month, observational cohort study.

SETTING: Twenty-two facilities which provide chronic care in southwestern Ontario.

PARTICIPANTS: Patients who were treated with systemic antibiotics over the study period.

MEASUREMENTS: Characteristics of antibiotic prescriptions (name, dose, duration, and indication) and clinical features of randomly selected patients who were treated with antibiotics.

RESULTS: A total of 9,373 courses of antibiotics were prescribed for 2,408 patients (66% of the patients in study facilities). The incidence of antibiotic prescriptions in the facilities ranged from 2.9 to 13.9 antibiotic courses per 1,000 patient-days. Thirty-six percent of antibiotics were prescribed for respiratory tract infections, 33% for urinary infections, and 13% for skin and soft tissue infections. Standardized surveillance definitions of infection were met in 49% of the 1,602 randomly selected patients who were prescribed antibiotics. Diagnostic criteria for respiratory, urinary, and skin infection were met in 58%, 28%, and 65% of prescriptions, respectively. One third of antibiotic prescriptions for a urinary indication were for asymptomatic bacteriuria. Adverse reactions were noted in 6% of prescriptions for respiratory and urinary infections and 4% of prescriptions for skin infection.

CONCLUSIONS: Antibiotic use is frequent and highly variable amongst patients who receive chronic care. Reducing antibiotic prescriptions for asymptomatic bacteriuria represents an important way to optimize antibiotic use in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mylotte JM. Measuring antibiotic use in a long-term care facility. Am J Infect Control. 1996;24:174–9.

    Article  PubMed  CAS  Google Scholar 

  2. Montgomery P, Semenchuk M, Nicolle LE. Antimicrobial use in nursing homes in Manitoba. J Geriatr Drug Ther. 1995;9:55–74.

    Article  Google Scholar 

  3. Warren JW, Palumbo FB, Fitterman L, Speedie SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc. 1991;39:963–72.

    PubMed  CAS  Google Scholar 

  4. Katz PR, Beam TR, Brand F, Boyce K. Antibiotic use in the nursing home. Physician practice patterns. Arch Intern Med. 1990;150:1465–8.

    Article  PubMed  CAS  Google Scholar 

  5. Smith PW. Nursing home infection control: a status report. Infect Control Hosp Epidemiol. 1998;19:366–9.

    PubMed  CAS  Google Scholar 

  6. Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA. 1996;275:234–40.

    Article  PubMed  CAS  Google Scholar 

  7. Armstrong-Evans M, Litt M, McArthur MA, et al. Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility. Infect Control Hosp Epidemiol. 1999;20:312–7.

    Article  PubMed  CAS  Google Scholar 

  8. Greenaway CA, Miller MA. Lack of transmission of vancomycin-resistant enterococci in three long-term-care facilities. Infect Control Hosp Epidemiol. 1999;20:341–3.

    Article  PubMed  CAS  Google Scholar 

  9. Wiener J, Quinn JP, Bradford PA, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA. 1999;281:517–23.

    Article  PubMed  CAS  Google Scholar 

  10. Terpenning MS, Bradley SF, Yan JY, Chenoweth CE, Jorgensen KA, Kauffman CA. Colonization and infection with antibiotic-resistant bacteria in a long-term care facility. J Am Geriatr Soc. 1994;42:1062–9.

    PubMed  CAS  Google Scholar 

  11. Wingard E, Shlaes JH, Mortimer EA, Shlaes DM. Colonization and cross-colonization of nursing home patients with trimethoprim-resistant gram-negative bacilli. Clin Infect Dis. 1993;16:75–81.

    PubMed  CAS  Google Scholar 

  12. Chenoweth CE, Bradley SF, Terpenning MS, et al. Colonization and transmission of high-level gentamicin-resistant enterococci in a long-term care facility. Infect Control Hosp Epidemiol. 1994;15:703–9.

    Article  PubMed  CAS  Google Scholar 

  13. Gaynes RP, Weinstein RA, Chamberlin W, Kabins SA. Antibiotic-resistant flora in nursing home patients admitted to the hospital. Arch Intern Med. 1985;145:1804–7.

    Article  PubMed  CAS  Google Scholar 

  14. Rice LB, Willey SH, Papanicolaou GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum B-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother. 1990;34:2193–9.

    PubMed  CAS  Google Scholar 

  15. Muder RR, Brennen C, Goetz AM, Wagener MM, Rihs JD. Association with prior fluoroquinolone therapy of widespread ciprofloxacin resistance among gram-negative isolates in a Veterans Affairs medical center. Antimicrob Agents Chemother. 1991;35:256–8.

    PubMed  CAS  Google Scholar 

  16. Nicolle LE, Bentley D, Garibaldi R, Neuhaus E, Smith P. Antimicrobial use in long-term care facilities. Infect Control Hosp Epidemiol. 1996;17:119–28.

    Article  PubMed  CAS  Google Scholar 

  17. Nicolle LE, Strausbaugh LJ, Garibaldi RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev. 1996;9:1–17.

    PubMed  CAS  Google Scholar 

  18. Strausbaugh LJ, Joseph C. In: Mayhall CG, ed. Hospital Epidemiology and Infection Control. Baltimore, Md: Williams and Wilkins; 1996:1151–70.

    Google Scholar 

  19. Zimmer JG, Bentley DW, Valenti WM, Watson NM. Systemic antibiotic use in nursing homes. A quality assessment. J Am Geriatr Soc. 1986;34:703–10.

    PubMed  CAS  Google Scholar 

  20. Jones SR, Parker DF, Liebow ES, Kimbrough RC, Frear RS. Appropriateness of antibiotic therapy in long-term care facilities. Am J Med. 1987;83:499–502.

    Article  PubMed  CAS  Google Scholar 

  21. McGeer A, Campbell B, Emori TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 1991;19:1–7.

    Article  PubMed  CAS  Google Scholar 

  22. Chambers LW, Labelle R, Gafni A, Goeree R. The Organization and Financing of Public and Private Sector Long Term Care Facilities for the Elderly in Canada, Chapter 6: Ontario Report. McMaster University Centre for Health Economics and Policy Analysis Working Paper 92-8; 1992.

  23. Nicolle LE. Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am. 1997;11:647–62.

    Article  PubMed  CAS  Google Scholar 

  24. Nicolle LE, Bjornson J, Harding GK, MacDonnel JA. Bacteriuria in elderly institutionalized men. N Engl J Med. 1983;309:1420–5.

    Article  PubMed  CAS  Google Scholar 

  25. Nicolle LE, Mayhew JW, Bryan L. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med. 1987;83:27–33.

    Article  PubMed  CAS  Google Scholar 

  26. Ouslander JG, Schapira JF, Schnelle JF, et al. Dose eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med. 1995;122:749–54.

    PubMed  CAS  Google Scholar 

  27. Abrutyn E, Mossey J, Berlin JA, et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women. Ann Intern Med. 1994;120:827–33.

    PubMed  CAS  Google Scholar 

  28. Garner JS, Bennett JV, Schechler WE, et al. Surveillance of nosocomial infections. In: Brachman PS, Eichhoff TC, eds. Proceedings of the International Conference on Nosocomial Infections. Chicago: American Hospital Association; 1971.

    Google Scholar 

  29. Muder RR. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. Am J Med. 1998;105:319–30.

    Article  PubMed  CAS  Google Scholar 

  30. Scully BE. Therapy of respiratory tract infections with quinolone antimicrobial agents. In: Hooper DC, Wolfson JS, eds. Quinolone Antimicrobial Therapy. 2nd ed. Washington, DC: American Society for Microbiology; 1993.

    Google Scholar 

  31. Chen DK, McGeer A, de Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med. 1999;341:233–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Received from the Division of Microbiology, Departments of Pathology, McMaster University, Hamilton, Ontario, Canada

    Mark Loeb MD, MSc

  2. Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

    Mark Loeb MD, MSc & Stephen Walter PhD

  3. Department of Microbiology and Infection Control, Mount Sinai and Princess Margaret Hospitals, Canada

    Lisa Landry BSc, Margaret McArthur RN, CIC & Allison McGeer MD

  4. Department of Microbiology, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Andrew E. Simor MD, Lisa Landry BSc, Margaret McArthur RN, CIC & Allison McGeer MD

  5. Departments of Infection Control and Pharmacy, Queen Elizabeth Hospital, Toronto, Ontario, Canada

    JoAnn Duffy RN, BScHs, CIC & Debora Kwan BScPhm, MSc

Authors
  1. Mark Loeb MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew E. Simor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Landry BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen Walter PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Margaret McArthur RN, CIC
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. JoAnn Duffy RN, BScHs, CIC
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Debora Kwan BScPhm, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Allison McGeer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Loeb MD, MSc.

Additional information

This study was supported by a grant from the Physicians Services Incorporated Foundation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Loeb, M., Simor, A.E., Landry, L. et al. Antibiotic use in ontario facilities that provide chronic care. J GEN INTERN MED 16, 376–383 (2001). https://doi.org/10.1046/j.1525-1497.2001.016006376.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1046/j.1525-1497.2001.016006376.x

Key words

Search

Navigation