title: Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use.
abstract: METHODS
  We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.
  
  
  METHODS
  A 160-bed VA LTCF.
  
  
  METHODS
  Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.
  
  
  RESULTS
  Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P=.008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β-lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P=.04).
  
  
  CONCLUSIONS
  Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA. robinjump@gmail.com
authors.forename: Robin L P
authors.initials: RL
authors.lastname: Jump
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Olds
authors.forename: Nasim
authors.initials: N
authors.lastname: Seifi
authors.forename: Georgios
authors.initials: G
authors.lastname: Kypriotakis
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Jury
authors.forename: Emily P
authors.initials: EP
authors.lastname: Peron
authors.forename: Amy A
authors.initials: AA
authors.lastname: Hirsch
authors.forename: Paul E
authors.initials: PE
authors.lastname: Drawz
authors.forename: Brook
authors.initials: B
authors.lastname: Watts
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D055552:Infectious Disease Medicine; D008134:Long-Term Care; D009582:Nitrofurantoin / Q000627:therapeutic use; D009735:Nursing Homes; D012017:Referral and Consultation; D012044:Regression Analysis; D013754:Tetracyclines / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D013754:Tetracyclines; D047090:beta-Lactams; D002981:Clindamycin; D002939:Ciprofloxacin; D014640:Vancomycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin