National trial aims to reduce unnecessary use of antibiotics in post-acute and long-term care facilities

University of Pittsburgh Schools of the Health SciencesJul 1 2015

The University of Pittsburgh School of Medicine will be leading a $1.5 million national trial to examine methods to reduce unnecessary use of antibiotics in post-acute and long-term care (PA/LTC) facilities.

The three-year study, funded by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), will investigate guidelines and tools to help PA/LTC facilities better manage urinary tract infections (UTIs), which are commonly misdiagnosed and incorrectly treated.

"Antimicrobial resistance is a hot button issue in health care nationally and internationally - and improper overutilization of antibiotics is the single largest culprit," said David A. Nace, M.D., M.P.H., director of long-term care and flu programs in Pitt's Division of Geriatric Medicine, and primary investigator on the AHRQ grant. "It is critically important that we find ways to cut unnecessary use of antibiotics."

The World Health Organization and the White House, among others, recently made announcements declaring efforts to address antimicrobial resistance top priorities. JAMA Internal Medicine published an article today finding that antibiotic use is highly variable across nursing homes, exposing residents to an increased risk of antibiotic-related harms and indicating a need to improve antibiotic stewardship in PA/LTC facilities.

The leading reason for antibiotic use at PA/LTC facilities is to treat a suspected UTI. Antibiotics often are started before a correct diagnosis is made. However, as many as two-thirds of those suspected cases turn out not to be UTIs, and the patients don't benefit from - and could be harmed by - the antibiotics.

When used incorrectly, antibiotics can kill good bacteria and allow harmful, drug-resistant bacteria to flourish. Antibiotics also can cause allergic reactions or side-effects and are the leading cause of adverse drug reactions in long-term care facilities.

Dr. Nace, also chief medical officer for UPMC Senior Communities, and his co-investigators at AMDA - The Society for Post-Acute and Long-Term Care Medicine and the University of Wisconsin are looking at existing guidance and research on UTIs to develop comprehensive guidelines and tools geared toward easy implementation at PA/LTC facilities. University of Wisconsin co-investigator Christopher Crnich, M.D., Ph.D., associate professor of medicine, is an expert in antimicrobial stewardship in long-term care facilities. AMDA has long been respected for improving care in nursing homes, and their reputation will be critical to disseminating the results of this project and improving care across the U.S.

Next year, the team will enroll 40 PA/LTC facilities from Pennsylvania, Texas, North Carolina and Wisconsin in their trial. Half will receive the guidelines, as well as on-going mentoring and education, while the other half will operate as normal.

For a year, the team will collect data on the number of UTIs before and after the trial, the rate of appropriate and inappropriate treatment, and adverse outcomes. Once the trial concludes, all the facilities will be given the guidelines, tools, mentoring and education.

"There's a lot of pressure across both agriculture and medicine to rein in use of antibiotics," said Dr. Nace. "We are very quickly running out of antibiotics to do the job for us, and the problem is only going to grow worse. New antibiotics are not being created and licensed fast enough to keep pace with bacterium's ability to develop drug-resistance. Efforts like ours to become better stewards of existing antibiotics are among the few solutions left at our disposal."