Another setting for stewardship: high rate of unnecessary antimicrobial use in a veterans affairs long-term care facility

J Am Geriatr Soc. 2013 Feb;61(2):289-90. doi: 10.1111/jgs.12099.


BACKGROUND/OBJECTIVE: Antimicrobials are frequently prescribed in long-term care facilities (LTCFs). In order to develop effective stewardship interventions, there is a need for data on current patterns of unnecessary antimicrobial prescribing among LTCF residents. The objective of this study was to examine the frequency of, reasons for, and adverse effects of unnecessary antimicrobial use in our Veterans Affairs (VA) LTCF.

DESIGN: Retrospective chart review.

SETTING: Cleveland VA Medical Center LTCF.

PARTICIPANTS: Randomly selected patients receiving antimicrobial therapy from October 1, 2008 to March 31, 2009.

MEASUREMENTS: Days of necessary and unnecessary antimicrobial therapy determined using Infectious Diseases Society of America guidelines, syndromes treated with unnecessary antimicrobials, and the frequency of development of Clostridium difficile infection (CDI), colonization or infection with antimicrobial resistant pathogens, and other adverse effects.

RESULTS: Of 1351 days of therapy prescribed in 100 regimens, 575 days (42.5%) were deemed unnecessary. Of the 575 unnecessary days of therapy, 334 (58%) were for antimicrobial regimens that were entirely unnecessary (n=42). Asymptomatic bacteriuria was the most common reason for entirely unnecessary regimens (n=21), resulting in 173 days of unnecessary therapy. Regimens that were partially unnecessary resulted in 241 (42%) days of unnecessary therapy, with longer than recommended treatment duration accounting for 226 (94%) unnecessary days of therapy. Within 30 days of completing the antimicrobial regimens, 5 patients developed CDI, 5 had colonization or infection with antimicrobial-resistant pathogens, and 10 experienced other adverse drug events.

CONCLUSIONS: In our VA LTCF, 43% of all days of antimicrobial therapy were unnecessary. Our findings suggest that antimicrobial stewardship interventions in LTCFs should focus on improving adherence to recommended treatment durations and eliminating inappropriate treatment of asymptomatic bacteriuria.

Publication types

  • Comparative Study
  • Letter
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Humans
  • Incidence
  • Long-Term Care / methods*
  • Nursing Homes*
  • Prevalence
  • Retrospective Studies
  • United States / epidemiology
  • Unnecessary Procedures / statistics & numerical data*
  • Veterans*


  • Anti-Bacterial Agents