title: Factors associated with antimicrobial use in nursing homes: a multilevel model.
abstract: OBJECTIVE
  To describe antimicrobial prescribing patterns in nursing homes.
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  Total of 73 nursing homes in four U.S. states; study period was from September 1, 2001, through February 28, 2002.
  
  
  METHODS
  Four thousand seven hundred eighty nursing home residents.
  
  
  METHODS
  Number and type of antimicrobials, indication for their use, and resident and facility factors associated with antimicrobial use in nursing homes.
  
  
  RESULTS
  Of 4,780 residents, 2,017 (42%) received one or more antibiotic courses. Overall, residents received a mean of 4.8 courses/1,000 resident-days (mean facility range 0.4-23.5). In multivariable analysis, higher probability of nursing home discharge and of being categorized in the rehabilitation, extensive services, special care, or clinically complex Resource Utilization Groups were associated with higher rates of antimicrobial usage. Three drug classes accounted for nearly 60% of antimicrobial courses-fluoroquinolones (38%), first-generation cephalosporins (11%), and macrolides (10%). The most common conditions for which antimicrobials were prescribed were respiratory tract (33%) and urinary tract (32%) infections.
  
  
  CONCLUSIONS
  Antibiotic use is variable in nursing homes. Targeting educational and other antimicrobial use interventions to the treatment of certain clinical diagnoses and conditions may be an appropriate strategy for optimizing antimicrobial use in this setting.
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Preventation, Atlanta, Georgia, USA. SBenoit@cdc.gov
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Benoit
authors.forename: Wato
authors.initials: W
authors.lastname: Nsa
authors.forename: Chesley L
authors.initials: CL
authors.lastname: Richards
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Shefer
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Steele
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009735:Nursing Homes; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000890:Anti-Infective Agents