High-risk antibiotic use common in nursing homes after hospitalization

Patients who are discharged to nursing homes following hospitalization are routinely prescribed antibiotics, some of which leave them at high-risk for subsequent C. diff infections, according to a new study published in JAMA Network Open.

The study, led by Kyle J. Gontjes, M.P.H., of the University of Michigan Health Division of Geriatric & Palliative Medicine, Payel Patel, M.D., of the Division of Infectious Disease and others, analyzed patient data for antibiotic prescriptions during a hospital stay and at post-acute nursing home stays. Nearly two thirds of included patients received antibiotics during their care, with the majority initiated during hospitalization. Sixty-four percent of the antibiotics prescribed were considered high-risk as defined by the World Health Organization's AWARE categorization system, a set of guidelines designed to slow the development of antibiotic resistance.

Exposure to antibiotics was associated with rehospitalization and infection with C. diff, a bacterium that afflicts 200,000 people per year in health care settings, causing diarrhea, gut pain and other intestinal issues. Patients who received antibiotics also tended to have rooms contaminated with multidrug resistant organisms or vancomycin-resistant enterococci (germs that can no longer be killed with vancomycin, a drug typically used to treat C. diff) when compared to patients who did not receive antibiotics.

The study findings unveil an opportunity to better coordinate hospital antimicrobial stewardship programs with nursing home practices to reduce rates of C. diff infection, colonization by resistant pathogens and high-risk antibiotic prescribing.

Paper cited: "Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes," JAMA Network Open. DOI: 10.1001/jamanetworkopen.2021.44959