Secondhand Antibiotic Exposure in Nursing Homes

Antibiotics are some of the most commonly prescribed medications in nursing homes. Past studies have shown that around 2 out of 3 nursing home residents receive an antibiotic every year, mostly for urinary tract and respiration infections. While there are benefits to antibiotic use when used appropriately, there are also significant downsides to the person being prescribed these drugs: Clostridium difficile infection and diarrhea, polypharmacy, medication side effects, and the potential for future development of antibiotic-resistant organisms.

But what about those living in the nursing home who aren’t prescribed these medications, is there a risk to them even if they aren’t the ones getting the antibiotic? A recent study that came out in JAMA IM showed that not only is antibiotic use highly variable across nursing homes, but their was an association with greater harms if you happen to live in a nursing home that used a lot of antibiotics, even if you didn’t get an antibiotic yourself.

The Study

The authors of the study linked healthcare datasets from the province of Ontario, Canada from 2010 and 2011. These datasets included information on nursing home residents, medication prescriptions, physician visits, emergency room visits, and hospitalizations. Nursing homes were classified into tertiles as being low, medium, and high antibiotic users based on days of use (importantly not number of treatment courses). Finally the authors assessed whether being within one of these tertiles had an effect on the individual risk of antibiotic-related adverse outcomes.

The Results

On average, 5 of every 100 days someone lived in a nursing home was a day they were also taking an antibiotic, although this number was highly variable depending on which nursing home you lived in, ranging from 2 to 20 antibiotic-days per 100 resident-days.

Antibiotic-related adverse events were more common (13.3%) in residents of high-use homes than that of medium-use (12.4%) or low-use homes (11.4%) (P< .001). And here is the kicker, this assoication remained true even for residents who didn’t get antibiotics.

The Take Home Point

Inappropriate antibiotic use for the treatment of things like asymptomatic bacturia not only affects the patient, putting them at risk for adverse outcomes, but also puts at risk the entire community of residents living in a nursing home.  So next time you are asked to check a urine culture for cloudy urine, just say no to secondhand antibiotic exposure.

by: Eric Widera (@ewidera)