Nursing Home Use of Antibiotics Affects Risk of Adverse Events

Residents in nursing homes with high antibiotic use have a 24% higher risk of an antibiotic-related adverse event, according to a new study published in JAMA from the Institute for Clinical Evaluative Sciences, located in Ontario, Canada.

The researchers studied more than 100,000 residents in more than 600 Ontario nursing homes and found a 10-fold variability in antibiotic use. The range was from as low as 20 antibiotic days per 1,000 resident days to as high as 200 antibiotic days. Antibiotic-related harms included C. difficile, diarrhea or gastroenteritis, allergic reactions, and general medication adverse events.

“Our findings show that these adverse outcomes affected not only residents who directly received antibiotics, but also those residents who did not directly receive antibiotics because infections like Clostridium difficile and antibiotic resistant bacteria can be transmitted between patients,” lead author Nick Daneman, MD, MSc, an adjunct scientist at ICES, said in a statement.

Even residents not receiving antibiotics could be at risk of adverse events. One of the antibiotic-related harms is antibiotic-resistant organisms, which not only affect the recipient, but also indirectly affect nonrecipients.

Overall, 13.3% of residents in a nursing home with high antibiotic use experience adverse antibiotic-related events compared with 11.4% of residents in a low antibiotic-use nursing home.

“Antibiotic use is highly variable across nursing homes; residents of high-use homes are exposed to an increased risk of antibiotic-related harms even if they have not directly received these agents,” the authors concluded. “Antibiotic stewardship is needed to improve the safety of all nursing home residents.”

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