Lead/Presenter: Haley Appaneal, COIN - Providence
All Authors: Appaneal HJ (Providence VAMC, Providence, RI, United States, University of Rhode Island, Kingston, RI, United States), Caffrey AR (Providence VAMC, Providence, RI, United States, University of Rhode Island, Kingston, RI, United States), Hughes MA (Providence VAMC, Providence, RI, United States) Lopes VV (Providence VAMC, Providence, RI, United States) Jump RLP (Cleveland VAMC, Cleveland, OH, United States) Dosa DM (Providence VAMC, Providence, RI, United States) LaPlante KL (Providence VAMC, Providence, RI, United States, University of Rhode Island, Kingston, RI, United States)
Antibiotic resistance is a global public health crisis, with antibiotic overuse contributing to selection pressure, and thus driving antibiotic resistance. Strategies to reduce antibiotic overuse may slow the development of resistance, but large-scale studies assessing trends in antibiotic use and resistance among nursing homes at the national level are limited. Here we describe trends in antibiotic use and resistance nationally among Veterans Affairs (VA) Community Living Centers (CLCs).
We assessed antibiotic use and microbiological cultures among VA CLC residents from 2011-2017. Antibiotics were grouped into eight drug classes (aminoglycosides, aminopenicillins, aminopenicillins/ beta-lactams, carbapenems, extended-spectrum cephalosporins, fluoroquinolones, anti-pseudomonal penicillin, and anti-staphylococcal penicillins) and annual days of antibiotic therapy per 1,000 bed days were calculated. Facility-weighted annual antibiotic resistance rates were calculated for Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa, Enterobacter spp., Enterococcus spp., and Staphylococcus aureus. Joinpoint Software was used for regression analyses of trends over time and to estimate annual average percent changes (AAPC) with 95% confidence intervals (CI).
Over the 7-year study period and among the 146 CLCs included, several significant trends in decreasing antibiotic use and corresponding reductions in resistance were identified. Fluoroquinolone use decreased by 9.9% annually (95% CI -11.6 to -8.2%) and fluoroquinolone resistance decreased by 2.3% per year for Escherichia coli, 5.1% for Klebsiella spp., 1.8% for Proteus mirabilis, 4.9% for Pseudomonas aeruginosa, 12.6% for Enterobacter spp., and 3.2% for Enterococcus spp. Anti-pseudomonal penicillin use decreased by 6.6% annually (95% CI -10.6 to -2.4%) and anti-pseudomonal penicillin resistance rates decreased each year by 7.9% for Escherichia coli, 8.9% for Klebsiella spp., 15.2% for Proteus mirabilis and 4.2% for Pseudomonas aeruginosa. Anti-staphylococcal penicillin use decreased by 5.4% annually (95% CI -10.0 to -0.5%) and resistance in Staphylococcus aureus decreased 1.7% per year.
Nationally among VA CLCs, we observed significant reductions in the use of several classes of antibiotics with corresponding reductions in antibiotic resistance, including an impressive decline in fluoroquinolone use and corresponding decreases in fluoroquinolone resistance among six organisms.
Future research should assess whether reductions in antibiotic use predict later reductions in antibiotic resistance and improvements in resident outcomes.