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Fig. 2. Measured and estimated median monthly days of therapy (DOT) rates (per 1,000 resident days) for the 3 most common antibiotic classes in each nursing home. *1st Gen Cephal: first-generation cephalosporins.
total antibiotic DOT without the labor of daily manual data collection. This analysis has several limitations. First, we included a small
number of nursing homes. Also, we were unable to differentiate between antibiotics initiated by the hospital or the nursing home, and we used dispensing data for which we could not confirm that a prescribed drug was administered. Additionally, antibiotic courses of<7 days may have been missed; however, no significant difference in the estimated and measured antibiotic DOT rate was found. Finally, we did not validate that nursing home staff could accurately replicate this antibiotic use measure using manual data collection. Future research is needed to determine whether this methodology can be replicated in other nursing homes. Our findings suggest that a weekly, 1-day point-prevalence
survey of antibiotic use is an accurate proxy of measured anti- biotic DOT. Identification of simple antibiotic use measurement methods that reduce staff burden can facilitate the participation of nursing homes in antibiotic use tracking as part of an antibiotic stewardship program.
Acknowledgments. We thank Elizabeth Dodds-Ashley, PharmD, for her guidance on the antibiotic measurement; Nicola Thompson, PhD, and Sarah Kabbani, MD, MSc, for their critical review of this manuscript.
Financial support. This work was supported by a grant for New York State Department of Health.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
Supplementary material. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2018.309
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