Background
Skilled nursing facility residents are at heightened risk for acquisition of antibiotic-resistant bacteria due to declining immune function, frequent healthcare contacts, institutional living, and selective antibiotic pressure. Suspected urinary tract infection (UTI), based on altered mental status and bacteriuria, with no other urinary symptoms, is the most common reason for antibiotic prescription in SNFs, although there is no evidence that antibiotic treatment improves outcomes in older adults with these syndromes.
Our overall objective is to improve the appropriateness of antibiotic prescribing through evidence-based ASP implementation. Our central hypothesis is that SNFs can reduce unnecessary antibiotic prescribing – and antibiotic-associated adverse events – through implementation of protocols that emphasize the use of standardized infection definitions to guide culturing and prescribing practices, administrative engagement, staff education, and consistent data feedback. Our preliminary data suggest that antibiotic use and C. difficile infections can reduced by at least 50% in SNFs with implementation of a simple protocol focused on prescribing for suspect urinary tract infections (UTIs). Learn more about this protocol in our brief report A syndrome-based approach to antimicrobial stewardship in an Arizona skilled nursing facility—Moving the needle through quality improvement.
