Nursing home residents face risks from antibiotics’ misuse
Antibiotic-resistant infections sicken millions and can kill
“There’s a real fear of under-treatment ... But giving antibiotics can be just as harmful as not.”
Victoria Walker, chief medical officer, Evangelical Lutheran Good Samaritan Society
Antibiotics are prescribed incorrectly to ailing nursing home residents up to 75% of the time, the nation’s public health watchdog says.
The reasons vary — wrong drug, wrong dose, wrong duration or just unnecessarily — but the consequences are scary, warns the Centers for Disease Control and Prevention. Overused antibiotics over time lose their effectiveness against the infections they were designed to treat. Some already have. And some antibiotics actually cause lifethreatening illnesses on their own.
The CDC last month advised all nursing homes to do more to protect more than 4 million residents from hard-to-treat superbugs that are growing in number and resist antibiotics.
Antibiotic-resistant infections threaten everyone, but elderly people in nursing homes are especially at risk because their bodies don’t fight infections as well. The CDC counts 18 top antibiotic- resistant infections that sicken more than 2 million people a year and kill 23,000. Those infections contribute to deaths in manymore cases.
The CDC is launching a public education campaign for nursing homes aimed at preventing more bacterial and viral infections from starting and stopping others from spreading. “One way to keep older Americans safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes,” said CDC Director Tom Frieden.
Studies have estimated antibiotics are prescribed inappropriately 40% to 75% of the time in nursing homes.
Here’s why that worries the CDC: Every time someone takes antibiotics, sensitive bacteria are killed but resistant bacteria survive and multiply— and they can spread to other people. Repeated use of antibiotics promotes growth of antibiotic-resistant bacteria.
Antibiotics also wipe out a body’s good infection-fighting bacteria along with the bad. When that occurs, such infections as Clostridium difficile can get out of control. C. diff. leads to serious diarrhea that each year puts 250,000 people in the hospital and kills 15,000.
Health care facilities already have infection-control procedures in place, such as providing private rooms and toi- lets for infected individuals. Still, the CDC is pushing them to do more on the prescribing side, advising nursing homes to track how many and what antibiotics they prescribe monthly and what the outcomes were for patients, including any side effects. Other recommendations include placing someone in charge of antibiotics policies and training other staff in following them.
Some of the suggestions could challenge nursing homes’ culture and how staffs, residents and families interact.
That’s changing at Evangelical Lutheran Good Samaritan Society, a nonprofit that offers senior care services in many states. It will collect data on vaccinations at one of its 167 nursing homes and share the results, said Victoria Walker, chief medical officer.
But better handling of antibiotics in nursing homes also requires tactful communication with residents’ families and nursing home doctors.
“There’s a real fear of under-treatment and that it is better to err on the safe side, and that means treating with antibiotics but forgetting about all the harms. But giving antibiotics can be just as harmful as not,” said Walker.
Family members may push for an antibiotic treatment when they visit a loved one in a nursing home who seems sick, even if they don’t know precisely what’s wrong. Doctors and nurses may go along because they don’t know either and it’s easier to treat than not. “The family will check in and ask what the doctor did and the nurse will say ‘nothing’ because they don’t see monitoring as doing anything,” said David Nace, director of long-term care at the University of Pittsburgh, who contributed to the CDC guidelines. “Practitioners are guilty of saying, ‘it’s just an antibiotic’ … We don’t appreciate the real threat,” he said.