Antibiotic Deescalation Opportunities for Residents in Assisted Living Facilities

June 15, 2022

Antibiotic prescribing patterns offer insights into clinical care across different health care settings, especially in nursing homes (NHs). These residents are highly susceptible to infection and are frequently inappropriately treated with antibiotics.1 Overuse and misuse of antibiotics is a common cause of adverse drug events, colonization, and infections caused by multidrug-resistant bacteria and Clostridioides difficile infection in NHs.2

Deescalation of empirically initiated broad-spectrum antibiotics after assessing response to therapy and culture results is a commonly recommended and appropriate antibiotic stewardship strategy.345 Although there has been at least 1 study examining patterns of postprescribing antibiotic modification and deescalation in NHs,6 to our knowledge, this practice has not been previously studied in assisted living facilities (ALFs). This research letter addresses this knowledge gap by identifying antibiotic deescalation opportunities in ALFs that could inform future ALFs postprescribing antibiotic stewardship interventions (Supplementary Material 1).

A prior study identified a total of 195 antibiotic events among 106 ALF residents.7 Among those 195 antibiotic events, 102 (52.3%) involved initial treatment with a broad-spectrum antibiotic and 93 (47.7%) involved initial treatment with a narrow-spectrum antibiotic (Table 1). Overall, antibiotic class modification occurred in only 15 (7.7%) of the antibiotic treatment events. Spectrum narrowing (broad-to narrow-spectrum antibiotic) changes was not observed, and all treatment modifications of antibiotic treatment events involving an initially prescribed broad-spectrum antibiotic (n = 7) were spectrum neutral (broad-to broad-spectrum antibiotic) changes. Spectrum broadening (narrow-to broad-spectrum antibiotic) change was observed in 6 instances where a narrow-spectrum antibiotic was prescribed initially and spectrum-neutral (narrow-to narrow-spectrum antibiotic) changes were observed in 2 instances. The high use of broad-spectrum antibiotics (52.3%) and prolonged treatment duration suggest that these are 2 potential targets for future antibiotic stewardship interventions in ALFs.