Reducing Antibiotic Overuse In Longer-Term Care

The University of Pittsburgh School of Medicine will lead a $1.5 million national trial to determine how to reduce unnecessary use of antibiotics in post-acute and long-term care facilities.

The three-year study will investigate guidelines to help such facilities better manage urinary tract infections, which are commonly misdiagnosed and incorrectly treated. The infections are also the leading reason for antibiotic use within post-acute and long-term care facilities.

The World Health Organization and the White House, among others, have made recent announcements declaring efforts to address antimicrobial resistance as top priorities. JAMA Internal Medicine published an article last month that said antibiotic use is highly variable across nursing homes, exposing residents to an increased risk of antibiotic-related harms.

“Antimicrobial resistance is a hot-button issue in health care nationally and internationally—and improper overutilization of antibiotics is the single largest culprit,” said David A. Nace, director of long-term care and flu programs in Pitt’s Division of Geriatric Medicine and primary investigator on the study. “It is critically important that we find ways to cut unnecessary use of antibiotics.”

Antibiotics often are started before a correct diagnosis of a urinary tract infection is made. But as many as two-thirds of those suspected cases are not urinary infections, and the patients don’t benefit from—and could be harmed by—the antibiotics.

When used incorrectly, antibiotics can kill good bacteria, allowing harmful, drug-resistant bacteria to flourish. Antibiotics also can cause allergic reactions or side effects and are the leading cause of adverse drug reactions in long-term care facilities.

Nace, who is also chief medical officer for UPMC Senior Communities, is working with coinvestigators at AMDA-The Society for Post-Acute and Long-Term Care Medicine and the University of Wisconsin. The study is funded by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).  

Next year, the team will enroll as trial participants 40 post-acute and long-term care facilities from Pennsylvania, Texas, North Carolina, and Wisconsin. Half will receive urinary tract infection treatment guidelines, as well as mentoring and education, while the other half will operate as normal.

For a year, the team will collect data on the number of infections before and after the trial, the rate of appropriate and inappropriate treatment, and adverse outcomes. Once the trial concludes, all the facilities will be given the guidelines, tools, mentoring, and education.

“There’s a lot of pressure across both agriculture and medicine to rein in use of antibiotics,” Nace said. “We are very quickly running out of antibiotics to do the job for us, and the problem is only going to grow worse. New antibiotics are not being created and licensed fast enough to keep pace with bacterium’s ability to develop drug resistance. Efforts like ours to become better stewards of existing antibiotics are among the few solutions left at our disposal.”