Don't “Bench” Long-Term Care Facilities: Benchmarking Antibiotic Use at Four Veterans Affairs Community Living Centers

Background:   Current estimates indicate that 50-75% of long-term care facility (LTCF) residents receive antibiotics annually, with 25-75% of those antibiotics deemed unnecessary.  There is little data describing overall antibiotic utilization at LTCFs, making it difficult to know which agents should be targeted for stewardship.

Objective:   Our objective was to benchmark antibiotic utilization among four Community Living Centers (CLCs), which are LTCFs within the Veterans Affairs (VA) system.

Methods:   We collected data on the days of systemic antibiotic therapy and bed days of care from four VA CLCs within a single Veterans Integrated Service Network (VISN).  We calculated days of therapy (DOT) per 1000 days of care (DOC) for antibiotic classes at each facility and compared the percent DOT/1000 DOC among the four CLCs.

Results:   The annual antibiotic use ranged from 62 – 198 DOT/1000 DOC.  Fluoroquinolones were the most commonly prescribed antibiotic class at all four CLCs, comprising about 30% of each facilityÕs total usage.  Within this class, ciprofloxacin use dominated (55-78%), compared to moxifloxcin (22-45%) and levofloxacin (<1%).  Beta-lactam/beta-lactamase inhibitor combinations were the next most common agents (9-19%).  There was no correlation between oral vancomycin, a medication used exclusively for the treatment of Clostridium difficile infection (CDI), and the administration of clindamycin, cephalosporins or fluoroquinolones, all of which have been linked to an increased risk for developing CDI.  Indeed, the facility with the highest use of clindamycin and cephalosporins (18% of its DOT/DOC) did not administer any oral vancomycin.  The facility with the fewest overall DOT/1000 DOC use administered the greatest proportion of sulfonamides and nitrofurantoin, suggesting a correlation between using narrow-spectrum agents and reduced overall antibiotic consumption.

Conclusions:   Antibiotic benchmarking among four VA CLCs provides insight into LTCF antibiotic prescribing practices, confirming heavy reliance upon fluoroquinolones, particularly ciprofloxacin.  Comparison of antibiotic utilization in conjunction with specific infectious diagnoses among individual facilities within the same healthcare system may suggest strategies to improve antibiotic stewardship at LTCFs, with the goal of reducing unnecessary prescription of antimicrobial agents.