246 - Title: Antibiotic Prescribing Patterns for Residents in Assisted Living Facilities

Background: Knowledge about antibiotic utilization in Assisted Living Facilities (ALFs) is limited. Studies have primarily focused on aggregate prescribing patterns, clinical indications for antibiotics, and the types of antibiotics prescribed. Information about individual resident prescribing patterns is limited. This project addresses the gap by using data from a convenient sample of ALFs.

Methods: Data on antibiotic prescriptions from 3 ALFs in Wisconsin were collected for a one-year period. Information included start and stop dates, clinical indication, and antibiotic prescribed. Antibiotic orders for the same resident were categorized as distinct events to capture treatment courses if 1) the days between the end date of the prior antibiotic and the initiation date of subsequent antibiotic orders were > 4 days, or 2) if the identified indications for the prior and subsequent antibiotic were different. Event-level indication was further defined based on (2). Descriptive statistics were used to understand antibiotic prescribing patterns at the individual and event level.

Results: A total of 207 antibiotic events among 110 assisted-living residents were identified. The patterns of antibiotic use at the resident and treatment course levels are described in tables 1 and 2, respectively. On average, each resident was received 1.9 (range:1 to 10) antibiotic treatment courses for an average of 24.8 (range: 1 to 237) total antibiotic days. The treatment duration of each treatment course averaged 14.5 days (range: 1 to 306). About 10 % of residents had 4 or more antibiotic events and days of therapy over 56 days. 43% of residents were prescribed an antibiotic without a clinical indication and 26% of the antibiotic events were not indicated. UTI was the most common indication for antibiotic treatment (31%) and ciprofloxacin was the most commonly prescribed antibiotic (22%).Table 1. Characteristics of antibiotic use per resident
Table 2. Characteristics of antibiotic events


Conclusion: The current study demonstrates multiple opportunities to improve antibiotic use in ALFs, including: 1) specification of indication for the antibiotic; 2) reducing unnecessary antibiotic treatments; 3) shortening durations of treatments; and 4) reducing use of broad-spectrum antibiotics. Studies on interventions that target these areas are needed.