Community hospitals, keystone referrers to local skilled nursing and rehabilitation centers, are not providing the correct antibiotic therapy to one in three patients with a bloodstream infection (BSI), according to a new study published in PLOS One.
Researchers found that many patients with healthcare-associated or community-acquired BSIs were given inappropriate antibiotic treatment or were given antibiotic treatment too late. Proper empiric antimicrobial therapy, the study authors noted, is giving the patient “an antimicrobial agent with in vitro activity against the infecting organism within 24 hours after the onset of infection.”
In addition, infection rates themselves are on the rise, including Staphylococcus aureus and MRSA, infections that have been more commonly associated with larger hospitals.
The study included data on 1,470 patients from nine community hospitals in North Carolina and Virginia from 2003-2006. Patients involved in the study data were an average age of 65, and 21 percent of them had come to the hospital from a nursing home. Researchers describe the study as “the most complete picture” of community hospital bloodstream infections to date.
“Our data confirm that appropriateness of empiric antimicrobial therapy is an important and needed performance metric for physicians and hospital stewardship programs,” the study authors concluded. “Risk of inadequate therapy is highest among patients with healthcare exposure and the disabled. Clinicians in community hospitals must identify these important risk factors when choosing antibiotic therapy, particularly given the adverse outcomes associated with inadequate therapy.”
For nursing homes and rehab centers that receive referrals from community hospitals, the study is a reminder of the importance of diligence when screening and treating new admissions, especially since infection rates can be compounded by the non-isolated environment of skilled nursing facilities. In order to protect their residents and reduce infection risk, some long-term care organizations are screening new residents at intake for infections like MRSA.
But, the challenges cut both ways for nursing homes and their acute care partners, the study’s data show. People who had been in any sort of healthcare environment were more likely to develop a BSI within acute care, as well. “More specifically, cases were more frequently admitted from a nursing facility (p<0.001) or hospitalized in the prior 12 months (p = 0.002),” the study stated.
Related article: One-on-one with... Phenelle Segal, RN, CIC