title: Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
abstract: BACKGROUND
  Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.
  
  
  OBJECTIVE
  To develop SNF-specific antibiograms and identify opportunities to improve antibiotic prescribing.
  
  
  METHODS
  Cross-sectional and pretest-posttest study among residents of 3 Maryland SNFs.
  
  
  METHODS
  Antibiograms were created using clinical culture data from a 6-month period in each SNF. We also used admission clinical culture data from the acute care facility primarily associated with each SNF for transferred residents. We manually collected all data from medical charts, and antibiograms were created using WHONET software. We then used a pretest-posttest study to evaluate the effectiveness of an antibiogram on changing antibiotic prescribing practices in a single SNF. Appropriate empirical antibiotic therapy was defined as an empirical antibiotic choice that sufficiently covered the infecting organism, considering antibiotic susceptibilities.
  
  
  RESULTS
  We reviewed 839 patient charts from SNF and acute care facilities. During the initial assessment period, 85% of initial antibiotic use in the SNFs was empirical, and thus only 15% of initial antibiotics were based on culture results. Fluoroquinolones were the most frequently used empirical antibiotics, accounting for 54.5% of initial prescribing instances. Among patients with available culture data, only 35% of empirical antibiotic prescribing was determined to be appropriate. In the single SNF in which we evaluated antibiogram effectiveness, prevalence of appropriate antibiotic prescribing increased from 32% to 45% after antibiogram implementation; however, this was not statistically significant ([Formula: see text]).
  
  
  CONCLUSIONS
  Implementation of antibiograms may be effective in improving empirical antibiotic prescribing in SNFs.
authors.affiliation: Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland, Oregon.
authors.forename: Jon P
authors.initials: JP
authors.lastname: Furuno
authors.forename: Angela C
authors.initials: AC
authors.lastname: Comer
authors.forename: J Kristie
authors.initials: JK
authors.lastname: Johnson
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Rosenberg
authors.forename: Susan L
authors.initials: SL
authors.lastname: Moore
authors.forename: Thomas D
authors.initials: TD
authors.lastname: MacKenzie
authors.forename: Kendall K
authors.initials: KK
authors.lastname: Hall
authors.forename: Jon Mark
authors.initials: JM
authors.lastname: Hirshon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D065187:Controlled Before-After Studies; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D058996:Quality Improvement; D012866:Skilled Nursing Facilities
chemical_list: D000900:Anti-Bacterial Agents