Antimicrobial use and suitability in long-term care facilities: A retrospective cross-sectional study
Bibliographic record
Abstract
Background: Antimicrobial stewardship is the promotion of responsible antimicrobial use to reduce antimicrobial resistance, antimicrobial toxicity and cost, and to reduce the incidence of nosocomial infections. Our objectives were to measure antibiotic use rate in 10 long-term care facilities (LTCF) during a 1-year period, and to determine the appropriateness of antimicrobial prescriptions. Methods: Antibiotic prescriptions from 10 long-term care facilities, between January 2015 and January 2016, were collected from a pharmacy database. A sample of500 prescriptions was randomly selected for chart review to determine the appropriateness of the prescribed antibiotic based on published guidelines. Results: We analyzed 3,148 prescriptions for 1,313 residents (2.40 prescriptions/patient/year, median duration 7 days). Antibiotic use rate was 21.16 Defined Daily Doses/1,000 patient-days/year, or 5.42 antibiotic days/1,000 patient-days/month. Of the 500 randomly selected prescriptions, 448 were analyzed for appropriateness. Mean age of included residents was 82.5 (SD 12.1 years). 288/448 (64.3%) were female, with an average activities of daily living (ADL) score of 19.3 (SD 8.5). Urinary tract infection was the most common indication for antibiotics (177/448, 39.5%), followed by lower respiratory tract infection (144/448, 32.1%) and skin and soft-tissue infection (76/448, 17.0%). 259/448 (57.8%) of prescriptions were inappropriate, including 115/163 (70.5%) given for urinary tract infection, 78/140 (55.7%) given for lower respiratory tract infection, and 15/68 (22.0%) given for skin and soft-tissue infection. Inappropriateness varied by long-term care facility (LTCF) between 18/41 (43.9%) and 15/21 (71.4%), and by drug class between 0/5 (0%) among penicillinase-resistant penicillins and 29/38 (76.3%) among macrolides. Conclusions: Antimicrobial use rate is high, and 57.8% of prescriptions are inappropriate. The least appropriate prescriptions are given for urinary tract infections. Appropriateness is highly variable by LTCF, indication, and drug class.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".