Measuring antibiotic use in a long term care facility

Background: In the long-term care facility setting, there is little information about correlation of antibiotic use with care delivered or with the occurrence of fever or use of Foley catheters. The objectives of this study were to compare various measures of quantitating antibiotic use and to correlate these measures with febrile morbidity and Foley catheter use in a hospital-based, long-term care facility. Methods: This was a prospective study in which the number of residents with fever (rectal temperature of 100.5 degrees F or greater) or a Foley catheter was documented daily. Antibiotic use was measured in several ways: incidence (courses per 100 resident care days), proportion of resident care days that were antibiotic days, the number of antibiotic courses per month, and the number of residents treated per month. Results: Between January and December 1989, 111 (71%) of 156 residents were prescribed 263 antibiotic courses. Incidence of antibiotic use was 0.61 courses per 100 resident care days. On average only about 5% of resident care days per month were associated with antibiotic use, whereas an average of 18 residents per month received antibiotic therapy. Trimethoprim/sulfa and ciprofloxacin together accounted for 55% of the courses prescribed. No significant correlations were found between any antibiotic use measure and febrile days or Foley catheter days each month. Conclusions: In the long-term care facility setting, monitoring the number of residents treated with antibiotics per month is a more practical and useful measure of use than measurement of resident care days on antibiotics per month.