Study Suggests Approaches to Creating Antibiograms for Long-Term Care Facilities
Antibiograms are important clinical tools to help guide antimicrobial therapy and support antibiotic stewardship. However, it is challenging for long-term care facilities (LTCFs) to create antibiograms due to the low number of bacterial isolates they are able to collect annually. An article in the September issue of JAMDA proposed some ways LTCFs can overcome this barrier and improve stewardship.
In “Antimicrobial Stewardship in Long-Term Care Facilities: Approaches to Creating an Antibiogram When Few Bacterial Isolates Are Cultured Annually,” the authors suggested some possible approaches to creating clinically useful antibiograms in this setting. These include extending the isolate data beyond one year, combining isolate data from other facilities in the same geographic region, using a nearby acute-care facility’s antibiogram as a proxy, and/or collapsing isolate data.
An antibiogram is a profile of antimicrobial susceptibility testing results regarding a particular microorganism. It is generated after bacteria are isolated from the patient’s tissues or bodily fluids and tested. Antibiograms can help guide the selection of an antibiotic likely to be effective against the offending bacteria. This information also helps the facility establish antibiotic-use protocols which, in turn, support antimicrobial stewardship efforts to reduce the prevalence of multidrug-resistant organisms and the risk of adverse drug events in this population.
It is important for practitioners and facilities to have adequate data to make informed decisions about antibiotic use and to promote stewardships; this is where the antibiogram is key. Without an antibiogram, the authors noted, antibiotics that have high resistance rates in a facility may be chosen inadvertently or broad-spectrum antibiotics may be used unnecessarily. In either case, this creates a potential for increased drug-resistance and infection prevalence.
The authors noted that each of their suggested approaches “has its advantages and limitations.” They recommend further research, “as the best approach to create antibiograms in LTCFs is currently unknown and may very well vary by facility.”
This study was conducted by researchers at the Veterans Affairs Medical Center Infectious Disease Research Program in Providence, RI; the Department of Pharmacy Practice at the University of Rhode Island College of Pharmacy in Kingston; the Geriatric Research Education and Clinical Center and the Specialty Care Center of Innovation at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Cleveland, OH; the Division of Infectious Diseases and HIV Medicine in the Department of Medicine and Department of Population and Quantitative Health Sciences at Case Western Reserve University in Cleveland, OH; and the Section of Infectious Diseases at the Washington, DC, Veterans Affairs Medical Center.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.