Changes in federal reimbursement policies led to fewer nursing home patients being admitted to hospitals from 2011-2013. This resulted in improved antibiotic sensitivity in key pathogens and decreased use of antibiotics used to treat multi-drug resistant infections at one urban community hospital. E. coli and Klebsiella pneumoniae sensitivities increased for several antibiotics like ceftriaxone and levofloxacin over this period. Usage of antibiotics used to treat multi-drug resistant organisms like colistin, carbapenems, and tigecycline also decreased from 27%, 25%, and 10% respectively. Admissions from nursing homes decreased as a percentage of total admissions from 20% in 2011 to 15% in 2013.

1. Changes in Nursing Home Reimbursement Associated with
Improvement of Antibiogram Data in an Urban Community Hospital
K. MCDONOUGH1, 2, S. SHAFI1, E.MAMMEN-PRASAD1, D. FINKEL3.
1East Orange General Hospital, East Orange, NJ, 2Cardinal Health, Houston, TX, 3Cross Roads Medical, Clifton, NJ
Conclusion
Disclosures
The authors of this presentation have the following to disclose concerning possible
financial or personal relationships with commercial entities that may have direct or
indirect interest in the subject matter of the presentation:
K. McDonough: Nothing to disclose
S. Shafi: Nothing to disclose
E. Mammen-Prasad: Nothing to disclose
D. Finkel: Nothing to disclose
Results
Changes in federal reimbursement affecting nursing home admissions
to hospitals may have kept patients with multi-drug resistant organism
infections out of the hospital, leading to the improvement of the
antibiogram and decreased utilization of antibiotics used to treat multi-
drug resistant organism infections.
Admissions from nursing homes as a percent of total admissions
decreased over the review period totaling 20%, 18%, and 15% for
2011, 2012, and 2013 respectively. Antibiogram sensitivities improved
over the study period. E. coli sensitivities improved for: ceftriaxone
(CT) (79%-85%), levofloxacin (LV) (51%-57%). Klebsiella
pneumoniae sensitivities improved for: gentamicin (71%-76%),
imipenem (IP) (59%-64%), LV (50%-60%), CT ( 45%-54%).
Pseudomonas aeruginosa sensitivities were mixed with sensitivities
improving for LV (50%-62%), and decreasing for IP (70%-67%) and
cefepime (80%-75%).
Data collected for DDD/1000PD showed decreased utilization of for
Colistin, Carbapenems, and Tigecycline by 27%, 25%, 10%
respectively over the review period.
Acknowledgment
We would like to acknowledge the generous support of Sonya Kim.
Background
Methods
The study comprised of review of inpatient antibiogram data, antibiotic
utilization, and percentage of inpatient admissions from nursing
homes. Sensitivity data was collated by the Microbiology Lab culture
and sensitivity reporting system. Antibiotic utilization statistics were
gathered for antibiotics used to treat multi-drug resistant organism
infection: tigecycline, carbapenems, and colistin. The data was
converted to defined daily doses per 1000 patient days
(DDD/1000PD). Percent of total admissions comprising nursing home
patients were obtained from hospital demographic data.
Multidrug resistant organism infections (MDROI) remain a significant
threat in hospitals and nursing homes.
East Orange General Hospital (EOGH) is a 210 bed urban acute care
community hospital located in East Orange, New Jersey. Primary
inpatient services include general medicine/surgery, HIV, non invasive
cardiac services, behavioral health, hemodialysis, emergency services
and limited oncology. East Orange General Hospital has had vigorous
infection control practices and an antibiotic stewardship program since
2000. Despite this practice, resistance trends remained stable until
our 2013 antibiogram.
The Federal Government changed Nursing Home reimbursement in
2011 resulting in fewer transfers to our facility. We hypothesize that
this would lead to decreased admissions to hospitals and a decrease
in MDROI. We report on our experience from 2011-13.
References
1. Joregensen J and Ferraro M. Antimicrobial Susceptibility Testing: A
Review of General Principles and Contemporary Practices. Clin Inf
Dis 2009;49:1749-55.
2. Colistimethate (package insert). Schaumberg, IL:APP
Pharmaceuticals, LLC; Apr 2008.
Results
Antibiogram Trends (2011-2013)
Selected antibiotic usage trend (2011-2013)
Nursing Home Admissions (2011-2013)