title: Antibiotic use in long-term care facilities.
abstract: OBJECTIVE
  Evaluation and optimization of antibiotic use (antibiotic stewardship) is being increasingly promoted as a means to reduce antibiotic resistance, adverse events, treatment complications and costs within institutions. Our goal was to examine the prevalence of antibiotic use among long-term care facility residents and the extent of variability across these institutions.
  
  
  METHODS
  We conducted a population-based, point-prevalence study of antibiotic use among elderly individuals (n = 37,371) residing in long-term care facilities (n = 363 institutions) in Ontario between April and June 2009, using linked healthcare databases from Canada's largest province. Facilities were grouped into quintiles according to their mean antibiotic dispensing rates and variation was compared across quintiles.
  
  
  RESULTS
  There were 2190 (5.9%) long-term care residents receiving antibiotic prescriptions on the study date. The three most prevalent antibiotics were agents most commonly used for the treatment of urinary tract infections, including nitrofurantoin (365, 15.4%), trimethoprim/sulfamethoxazole (338, 14.3%) and ciprofloxacin (304, 12.8%). The majority of treatment courses were at least 10 days in duration (1482, 62.6%), and many exceeded 90 days (495, 20.9%), suggesting chronic prophylaxis. There was substantial variability in antibiotic use across facilities, with a 5-fold variation from the highest-use quintile (10.8%) to the lowest-use quintile (2.2%). This variation persisted after adjustment for multiple facility-level and resident-level factors, including demographic characteristics, healthcare utilization statistics, co-morbidity prevalence, functional status and device dependence.
  
  
  CONCLUSIONS
  Antibiotic use is common among long-term care residents, variable across institutions, and may benefit from focused antimicrobial stewardship interventions to standardize treatment indications and duration.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. nick.daneman@sunnybrook.ca
authors.forename: Nick
authors.initials: N
authors.lastname: Daneman
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.forename: Alice
authors.initials: A
authors.lastname: Newman
authors.forename: Hadas D
authors.initials: HD
authors.lastname: Fischer
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bronskill
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
authors.forename: Geoff M
authors.initials: GM
authors.lastname: Anderson
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D009864:Ontario
chemical_list: D000900:Anti-Bacterial Agents