Key Points
➤ Antibiotics are among the most common medications prescribed in
nursing homes.
➤ The annual prevalence of antibiotic use in residents of nursing homes
ranges from 47% to 79%. More than half of antibiotic courses initiated
in nursing home settings are unnecessary or prescribed inappropriately
(wrong drug, dose, or duration).
➤ Inappropriate antibiotic use is associated with a variety of negative
consequences including Clostridioides difficile (formerly Clostridium
difficile) infection, adverse drug effects, drug-drug interactions, and
antimicrobial resistance.
➤ In response to this problem, public health authorities have called for
efforts to improve the quality of antibiotic prescribing in nursing homes.
➤ The guidance
1
is intended to reflect an assessment of the strength of
association between bacterial infections and geriatric manifestations and
should not be used as the basis for excluding a diagnosis of respiratory
viral pathogens.
Symptoms That Should Prompt Further Evaluation for Infection
Fever
➤ The authors recommend that criteria set forth in the "Clinical Practice
Guideline for the Evaluation of Fever and Infection in Older Adult
Residents of Long-Term Care Facilities: 2008 Update of the Infectious
Disease Society of America" [High KP et al. Clin Infect Dis. 2009;48:149-
71] be used to establish the presence of fever in a resident of a nursing
home. These include any of the following:
• A single temperature of >100°F (>37.8°C) OR
• Repeated temperatures of >99°F (>37.2°C) OR
• An increase in temperature of >2°F (>1.1°C) over the resident's baseline non-illness
temperature.
The authors recommend that clinicians perform further evaluation for
infection in residents who meet one or more of the above definitions of
fever, while considering the possibility of non-infectious causes of fever.
Management
