Article Recommends Metrics for Antimicrobial Stewardship in Long-Term Care

​Long-term care facilities may wish to use incidence of antibiotic use or an antibiotic utilization ratio as a metric for monitoring antibiotic use in long-term care, states an article in the July 2016 JAMDA. The Centers for Disease Control and Prevention (CDC) has outlined core elements for antimicrobial stewardship programs in long-term care, and the Centers for Medicare and Medicaid Services' proposed overhaul of the long-term care regulations includes requirements for antimicrobial stewardship programs. However, guidelines and studies have paid little attention to metrics or risk adjustment. The author reviewed guidelines, position papers, and studies of specific interventions. One metric that the article recommends is incidence of antibiotic use, defined as the number of antibiotic courses started per 1,000 resident-days. This metric gives the number of residents treated each month and may help monitor the effectiveness of interventions to reduce antibiotic use. The other recommended metric is the antibiotic utilization ratio, defined as the number of days of therapy per 1,000 resident-days. This ratio is used by CDC's National Healthcare Safety Network and in many studies and may help monitor the effectiveness of interventions to reduce antibiotic use.