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Compiled Thesis_RRC_201807_v5.pdf (2.82 MB)

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ANTIBIOTIC STEWARDSHIP IN AMERICAN NURSING HOMES

Carter, Rebecca Rosaly, Carter
http://rave.ohiolink.edu/etdc/view?acc_num=case1538588980802258

Abstract Details

2018, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
Antibiotic resistance is a public health crisis. Infections caused by antibiotic resistant bacteria lead to over 2.5 million infections and 23,000 deaths annually in the United States (US). Non-judicious use of antibiotics can accelerate what should be avoidable selective pressure, accelerating the evolution of antibiotic resistant bacteria. Although any antibiotic exposure, whether appropriate or not, may contribute to the selection of antibiotic resistant bacteria, failure to follow clinical prescribing guidelines make the problem worse. In American Long-Term Care Facilities (LTCFs) up to 75% of antibiotic prescriptions do not meet these guidelines. Antibiotic stewardship, which seeks to minimize inappropriate or unnecessary antibiotic use, is one solution to combating antibiotic-resistant bacteria. Antibiotic stewardship is urgently needed in LTCFs to improve resident outcomes and to reduce selection for antibiotic-resistant bacteria. Driven by both the increasing prevalence of antibiotic-resistant bacteria and recent federal mandate from the Centers for Medicare and Medicaid Services, LTCFs across the US are rapidly implementing antibiotic stewardship programs (ASPs). ASPs are coordinated approaches for harmonizing competing concerns of adequate spectrum of coverage, adverse events, and resistance. The CMS mandate will be enforced through a range of sanctions ranging from civil fines to closure of the facility. To date, LTCFs have been slow to adopt stewardship measures. Studies of US LTCFs are limited and there is also a paucity of well-validated strategies specific to these healthcare settings. Despite emerging evidence of successful stewardship in a selection of US LTCF settings, adoption may be bottlenecked due to personnel who may lack training or experience in data collection and analysis, funding or logistical constraints, prescriber’s decision-making autonomy, or few electronic resources. The objective of this dissertation is to examine the patterns of antibiotic use in LTCFs, as well as views of LTCF providers about that use. Such knowledge should provide critical information necessary to design strategies for improving antibiotic stewardship in LTCFs. Our goal is to identify actionable, pragmatic targets to support specific strategies for responsible antibiotic use with the intent of improving care of LTCF residents.
Alfred Rimm, PhD (Committee Chair)
Robin Jump, MD, PhD (Advisor)
Scott Williams, PhD (Committee Member)
Siran Koroukian, PhD (Committee Member)
Stefan Gravenstein, MD, MPH (Committee Member)
159 p.
Biostatistics; Epidemiology; Medicine
antibiotic stewardship; long-term care facilities; geriatric health; antibiotic overuse; broad-spectrum; narrow-spectrum; mixed-methods; crowdsourcing; administrative claims data; patterns of antibiotic use; antibiotics; antibiotic resistance

Recommended Citations

Citations

  • Carter, Carter, R. R. (2018). ANTIBIOTIC STEWARDSHIP IN AMERICAN NURSING HOMES [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1538588980802258

    APA Style (7th edition)

  • Carter, Carter, Rebecca. ANTIBIOTIC STEWARDSHIP IN AMERICAN NURSING HOMES. 2018. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1538588980802258.

    MLA Style (8th edition)

  • Carter, Carter, Rebecca. "ANTIBIOTIC STEWARDSHIP IN AMERICAN NURSING HOMES." Doctoral dissertation, Case Western Reserve University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1538588980802258

    Chicago Manual of Style (17th edition)

case1538588980802258
148
© 2018, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.