Skip to main content

Secondhand Antibiotic Exposure in Nursing Homes



Antibiotics are some of the most commonly prescribed medications in nursing homes. Past studies have shown that around 2 out of 3 nursing home residents receive an antibiotic every year, mostly for urinary tract and respiration infections. While there are benefits to antibiotic use when used appropriately, there are also significant downsides to the person being prescribed these drugs: Clostridium difficile infection and diarrhea, polypharmacy, medication side effects, and the potential for future development of antibiotic-resistant organisms.

But what about those living in the nursing home who aren’t prescribed these medications, is there a risk to them even if they aren’t the ones getting the antibiotic? A recent study that came out in JAMA IM showed that not only is antibiotic use highly variable across nursing homes, but their was an association with greater harms if you happen to live in a nursing home that used a lot of antibiotics, even if you didn't get an antibiotic yourself.

The Study

The authors of the study linked healthcare datasets from the province of Ontario, Canada from 2010 and 2011. These datasets included information on nursing home residents, medication prescriptions, physician visits, emergency room visits, and hospitalizations. Nursing homes were classified into tertiles as being low, medium, and high antibiotic users based on days of use (importantly not number of treatment courses). Finally the authors assessed whether being within one of these tertiles had an effect on the individual risk of antibiotic-related adverse outcomes.

The Results

On average, 5 of every 100 days someone lived in a nursing home was a day they were also taking an antibiotic, although this number was highly variable depending on which nursing home you lived in, ranging from 2 to 20 antibiotic-days per 100 resident-days.

Antibiotic-related adverse events were more common (13.3%) in residents of high-use homes than that of medium-use (12.4%) or low-use homes (11.4%) (P< .001). And here is the kicker, this assoication remained true even for residents who didn't get antibiotics.

The Take Home Point

Inappropriate antibiotic use for the treatment of things like asymptomatic bacturia not only affects the patient, putting them at risk for adverse outcomes, but also puts at risk the entire community of residents living in a nursing home.  So next time you are asked to check a urine culture for cloudy urine, just say no to secondhand antibiotic exposure.

by: Eric Widera (@ewidera)

Comments

John Hopkins said…
Well done!
I have a saying in my assisted living facilities' infection control lectures: cooties don't have legs or wings...
Universal precautions...We get a lot of Canadians here in New Hampshire for the Summah. We have to remind them to wash their hands.
John Hopkins Dr. P.H.

Popular posts from this blog

Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care.  His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times.  As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice.  I mean, nuts and bolts practical advice.  Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die?  …

Improving Advance Care Planning for Latinos with Cancer: A Podcast with Fischer and Fink

In this week's GeriPal podcast we talk with Stacy Fischer, MD and Regina Fink, RN, PhD, both from the University of Colorado, about a lay health navigator intervention to improve advance care planning with Latinos with advanced cancer.  The issue of lay health navigators raises several issues that we discuss, including:
What is a lay health navigator?What do they do?  How are they trained?What do lay health navigators offer that specialized palliative care doesn't?  Are they replacing us?What makes the health navigator intervention particularly appropriate for Latinos and rural individuals?  For advance care planning? Eric and I had fun singing in French (yes French, not Spanish, listen to the podcast to learn why).
Enjoy! -@AlexSmithMD




You can also find us onYoutube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher

Transcript

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, I'm really excited about toda…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …