135. Influence of Prescribers on Antibiotic Use among Skilled Nursing Care Residents in 29 U.S. Nursing Homes

Abstract Background In nursing homes, federal mandates call for more judicious use of antibiotics and antipsychotics. Previous research indicates that practice patterns of nursing home practitioners, rather than resident’s signs and symptoms or overall medical conditions, drive antibiotic use. We hypothesized that nursing home practitioners who prescribe antibiotics more frequently than their peers may display a similar practice pattern for antipsychotics. Here, we examine similarities in prescribing patterns for antibiotics and antipsychotics among practitioners at 29 U.S. nursing homes. Methods Prescription data came from 2016 invoices from a pharmacy common to all 29 nursing homes. We defined practitioners as individuals who prescribed ≥1% of systemic medications at a nursing home and excluded practitioners without no prescriptions for anti-hypertensive drugs assuming they were not treating a general nursing home population (i.e. treating hospice or dementia patients). Using anti-hypertensive starts for standardization, we calculated the expected number of starts for both antibiotics and antipsychotics. Using funnel plots with Poisson 99% control limits for the observed-to-expected ratio, we identified practitioners whose use of either class of drugs exceeded these control limits. Practitioners were classified as high, average, or low prescribers for each class of drugs. Results We analyzed 129 practitioners who wrote for 113669 systemic medications. For antibiotics, 27 (20%) and 19 (15%) of practitioners were low and high prescribers, respectively. For antipsychotics, 53 (41%) and 14 (11%) were low and high prescribers, respectively (Figure 1). Among the low antibiotic prescribers, 59% (16/27) were also low antipsychotic prescribers. Among the high antibiotic prescribers, 21% (4/19) were also high antipsychotic prescribers (Figure 2). Figure 1. (a) Funnel plot for antibiotics (b) Funnel plot for antipsychotics Figure 2. Type of prescriber Conclusion Practitioners who were low prescribers for antibiotics were also likely to be low prescribers for antipsychotics, suggesting judicious use for both classes of medications. Further understanding of the behaviors of these individuals, as well as those who are high prescribers for both classes, has implications for improving antibiotic stewardship practices in nursing homes. Disclosures Robin L. Jump, MD, PhD, Pfizer (Individual(s) Involved: Self): Consultant

Background. In nursing homes, federal mandates call for more judicious use of antibiotics and antipsychotics. Previous research indicates that practice patterns of nursing home practitioners, rather than resident's signs and symptoms or overall medical conditions, drive antibiotic use. We hypothesized that nursing home practitioners who prescribe antibiotics more frequently than their peers may display a similar practice pattern for antipsychotics. Here, we examine similarities in prescribing patterns for antibiotics and antipsychotics among practitioners at 29 U.S. nursing homes.
Methods. Prescription data came from 2016 invoices from a pharmacy common to all 29 nursing homes. We defined practitioners as individuals who prescribed ≥1% of systemic medications at a nursing home and excluded practitioners without no prescriptions for anti-hypertensive drugs assuming they were not treating a general nursing home population (i.e. treating hospice or dementia patients). Using anti-hypertensive starts for standardization, we calculated the expected number of starts for both antibiotics and antipsychotics. Using funnel plots with Poisson 99% control limits for the observed-to-expected ratio, we identified practitioners whose use of either class of drugs exceeded these control limits. Practitioners were classified as high, average, or low prescribers for each class of drugs.
Results. We analyzed 129 practitioners who wrote for 113669 systemic medications. For antibiotics, 27 (20%) and 19 (15%) of practitioners were low and high prescribers, respectively. For antipsychotics, 53 (41%) and 14 (11%) were low and high prescribers, respectively (Figure 1). Among the low antibiotic prescribers, 59% (16/27) were also low antipsychotic prescribers. Among the high antibiotic prescribers, 21% (4/19) were also high antipsychotic prescribers (Figure 2). Conclusion. Practitioners who were low prescribers for antibiotics were also likely to be low prescribers for antipsychotics, suggesting judicious use for both classes of medications. Further understanding of the behaviors of these individuals, as well as those who are high prescribers for both classes, has implications for improving antibiotic stewardship practices in nursing homes.
Disclosures. Robin L. Jump, MD, PhD, Pfizer (Individual(s) Involved: Self): Consultant Background. As access to cancer treatment has increased in sub-Saharan Africa (sSA), infection-related complications are a growing concern. Little is known about infection management practices in this setting. Understanding the unique challenges to diagnosing and treating infections can inform the development of targeted strategies to improve infection management for cancer treatment programs throughout sSA.

Attitudes and Practices of Antimicrobial Resistance and Antimicrobial Stewardship at the Uganda Cancer Institute
Methods. We conducted a cross-sectional survey of doctors, nurses, and pharmacists at the Uganda Cancer Institute (UCI), a national cancer referral hospital in Kampala, Uganda. The 25-item survey was designed to assess staff knowledge of antimicrobial resistance and antimicrobial stewardship, investigate antibiotic decision-making practices, and identify barriers to diagnosing and treating infections.
Results. Of the 61 respondents, 25 (41%) were doctors, 7 (11%) were pharmacists, and 29 (48%) were nurses. In total, 98% (60/61) had heard of the term "antimicrobial resistance" and 84% (51/61) agreed that antimicrobial resistance is an important problem at UCI. Multiple factors were felt to contribute to antimicrobial resistance including the use of too many antibiotics, patient insistence on antibiotics, and poor patient adherence (Fig 1). While 72% (44/61) had heard of the term "antimicrobial stewardship", only 25% (15/61) knew a lot about what it meant. Numerous factors were considered important to antibiotic decision-making including patient white blood cell count and severity of illness (Fig 2). Perceived barriers to infection diagnosis included the inability to obtain blood cultures and to regularly measure patient temperatures; perceived barriers to obtaining blood cultures included patient cost and availability of supplies (Fig 3). Figure 1. Factors that doctors, pharmacists, and nurses working at the Uganda Cancer Institute (UCI) perceive as contributing to antimicrobial resistance at the UCI.
Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor does not or usually does not contribute (left of bars, main chart), occasionally or frequently contributes (right of bars, main chart), or neither contributes nor does not contribute (right of neutral chart). Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor is somewhat or very unimportant (left of bars,