OBJECTIVE Nursing homes (NHs) are an important target for antibiotic stewardship (AS). We describe a collaborative model to reduce Clostridioides difficile infections (CDIs) in NHs through optimization of antibiotic use including a reduction in high-risk antibiotics such as fluoroquinolones. DESIGN Quasi-experimental, pre- and post-intervention study. SETTING AND PARTICIPANTS Six NHs in Monroe County, NY. METHODS A hospital-based AS expert team assisted NHs in identifying targets for improving antibiotic use. Interventions included (1) collaboration with a medical director advisory group to develop NH consensus guidelines for testing and treatment of 2 syndromes (urinary tract infections and pneumonia) for which fluoroquinolone use is common, (2) provision of multifaceted NH staff education on these guidelines and education of residents and family members on the judicious use of antibiotics, and (3) sharing facility-specific and comparative antibiotic and CDI data. We used Poisson regression to estimate antibiotic use per 1000 resident days (RD) and CDIs per 10,000 RD, pre- and post-intervention. Segmented regression analysis was used to estimate changes in fluoroquinolone and total antibiotic rates over time. RESULTS Postintervention, the monthly rate of fluoroquinolone days of therapy (DOT) per 1000 RD significantly decreased by 39% [rate ratio (RR) 0.61, 95% confidence interval (CI) 0.59-0.62, P < .001] across all NHs and the total antibiotic DOT decreased by 9% (RR 0.91, 95% CI 0.90-0.92, P < .001). Interrupted time series analysis of fluoroquinolone and total DOT rates confirmed these changes. The quarterly CDI rate decreased by 18% (RR 0.82, 95% CI 0.68-0.99, P = .042). CONCLUSIONS AND IMPLICATIONS A hospital-NH partnership with a medical director advisory group achieved a significant reduction in total antibiotic and fluoroquinolone use and contributed to a reduction in CDI incidence. This approach offers one way for NHs to gain access to AS expertise and resources and to standardize practices within the local community.

中文翻译：

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通过医院-疗养院合作减少社区疗养院中氟喹诺酮类药物的使用和艰难梭菌感染

目标 疗养院 (NH) 是抗生素管理 (AS) 的重要目标。我们描述了一种协作模型，通过优化抗生素使用（包括减少氟喹诺酮类等高风险抗生素）来减少 NH 中的艰难梭菌感染 (CDI)。设计 准实验、干预前和干预后研究。地点和参与者 纽约州门罗县的六个 NH。方法 一个以医院为基础的 AS 专家团队协助 NH 确定改善抗生素使用的目标。干预措施包括 (1) 与医学主任咨询小组合作制定 NH 共识指南，用于检测和治疗氟喹诺酮类药物常见的 2 种综合征（尿路感染和肺炎），(2) 为 NH 员工提供有关这些指南的多方面教育，并对居民和家庭成员进行明智使用抗生素的教育，以及 (3) 共享特定设施和比较抗生素和 CDI 数据。我们使用泊松回归来估计干预前和干预后每 1000 个住院日 (RD) 的抗生素使用量和每 10,000 个 RD 的 CDI。分段回归分析用于估计氟喹诺酮类药物和抗生素总用量随时间的变化。结果 干预后，所有 NH 和 1000 RD 的氟喹诺酮治疗天数 (DOT) 的月率显着降低了 39% [率比 (RR) 0.61，95% 置信区间 (CI) 0.59-0.62，P < .001]总抗生素 DOT 降低了 9%（RR 0.91，95% CI 0.90-0.92，P < .001）。氟喹诺酮和总 DOT 率的中断时间序列分析证实了这些变化。季度 CDI 率下降了 18%（RR 0.82，95% CI 0.68-0.99，P = .042）。结论和意义 医院-NH 与医疗主任咨询小组的合作显着减少了抗生素和氟喹诺酮类药物的总使用量，并有助于降低 CDI 发生率。这种方法为 NH 提供了一种获取 AS 专业知识和资源并在当地社区内标准化实践的方法。