“Aging should be a continued stage of development and growth, rather than a period of decline.” ~The Eden Alternative Antimicrobial Stewardship. Disease Control & Prevention

1. Health is the Greatest Gift;
Contentment, the Greatest Wealth
Providing Tools for a Healthier,
More Abundant Quality of Life
“Aging should
be a continued stage of development and
growth, rather than a period of decline.”
~The Eden Alternative
QoLQoL

2. Antimicrobial Stewardship In Nursing Homes
The Centers for Medicare and Medicaid Services (CMS) has finalized a new rule that requires
nursing homes to have an antibiotic stewardship program.
“The changes are aimed at improving the quality of care and strengthening safety measures for
residents, and reducing unnecessary hospital readmissions and infections. Nursing homes, skilled
nursing facilities, and assisted-living facilities must meet these new standards to receive
Medicare and Medicaid payments.” ~cms.gov
Residents are often frail and have underlying chronic conditions that make them more vulnerable
to infections, especially involving the skin, urinary tract, and respiratory tract. In addition,
bacterial infections tend to spread rapidly in these facilities because of patient proximity and
frequent nurse-resident contact.
QoL

3. Antimicrobial Stewardship in Long Term Care
What is antimicrobial stewardship?
 Interventions designed to improve and
measure appropriate use of antimicrobials;
 Selection of optimal antimicrobial drug and
regimen – dose, duration of therapy, route of
administration
 Objectives are to achieve best clinical
outcomes related to antimicrobial use while:
 Minimizing toxicity and other adverse
events, like C. difficile infection
 Limiting selective pressure that drives
the emergence of antimicrobial resistance
 Reducing excessive costs attributable
to suboptimal antimicrobial use
QoL

4. % of Antimicrobials
Prescribed in LTCF
Antimicrobials Other
Inappropriate
Antibiotic Prescriptions
Antibiotics Other
Why is antimicrobial stewardship important in long
term care (LTC)?
• 40% of all systemic drugs prescribed in LTC are
antimicrobials
• 25-75% of antibiotic prescriptions for LTC residents
are inappropriate
• Inappropriate use of antimicrobials increases C.
difficile infection, selection of multidrug-resistant
organisms, drug-drug interactions, and other
adverse events
• Risk for colonization and infection with antibiotic-
resistant organisms is high; residents travel between
healthcare facilities and the community
QoL

5. “The optimism of the early period of antimicrobial discovery has been tempered by the emergence
of bacterial strains with resistance to these therapeutics. Today, clinically important
bacteria are characterized not only by single drug resistance but also by multiple
antibiotic resistance — the legacy of past
decades of antimicrobial use and misuse. Drug
Resistance presents an ever-increasing global
public health threat that involves all major
microbial pathogens and antimicrobial drugs.”
The Impact of Antibiotic Resistance on the Outcome
and Costs of Patient Care
QoL

6. “Each year in the United States, at least 2 million people become
infected with bacteria that are resistant to antibiotics and at least
23,000 people die…”
Antibiotic Prescribing and Use Policies
High rates of infection, has raised the
concern that nursing homes are becoming a
significant reservoir of multidrug- resistant
bacteria in the community. And given that
long term care facility residents are
frequently transferred to acute care
facilities, those bugs can then spread into
healthcare settings.
QoL

7. Reduce Antibiotic Use in Asymptomatic Bacteriuria
(ASB)
The prevalence of ASB, bacteriuria without localizing signs or symptoms of infection, ranges from
25% to 50% in non-catheterized nursing home residents and up to 100% among those with
long-term urinary catheters. Antibiotic use for treatment of ASB in nursing home residents
does not confer any long-term benefits, and may actually increase the incidence of adverse drug
events and result in subsequent infections with antibiotic-resistant pathogens.
Suspected UTIs account for 30% to 60% of antibiotic prescriptions in nursing homes.
Implementing a set of diagnostic testing and management algorithms to
help providers differentiate ASB from symptomatic UTI has been shown to reduce
inappropriate antibiotic use for ASB.
QoL
“The unreliable clinical assessment for infections in nursing home
residents coupled with the diagnostic uncertainties in differentiating
ASB from infection contributes greatly to inappropriate antibiotic use.”

8. Surgical Site Infection Outcomes Related to Methicillin
Resistant S. aureus (MRSA)
$34,395
$73,165
$118,41
4
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
Cost
SSI MSSA SSI MRSA SSI
6.1
13.2
29.1
0
5
10
15
20
25
30
35
Length of Stay
SSI MSSA SSI MRSA SSI
QoL
2.1%
6.7%
20.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Mortality %
SSI MSSA SSI MRSA SSI

9. Outcomes Related to E. coli and K. pneumoniae
Infections with *ESBLs
9%
15%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Mortality %
Negative ESBL Positive ESBL
$22,231
$65,590
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
Cost
Negative ESBL Positive ESBL
7
11
0
2
4
6
8
10
12
Length of Stay
Negative ESBL Positive ESBL
QoL
* Extended-spectrum β-lactamase (ESBL)

10. Outcomes Related to the Emergence of Cephalosporin
Resistant Enterobacter sp. (HAI)
13%
24%
0%
5%
10%
15%
20%
25%
30%
Mortality %
Resistance at Baseline
Emergence at Baseline
$43,456
$79,323
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
Cost
Resistance at Baseline
Emergence at Baseline
13
23
0
5
10
15
20
25
Length of Stay
Resistance at Baseline
Emergence at Baseline
QoL

11. 0 2 4 6 8 10 12 14 16 18
TOTAL NUMBER OF NEW
ANTIBACTERIAL AGENTS
2008-2012 2003-2007 1998-2002
1993-1997 1988-1992 1983-1987
“Diatherix and
Thermo Fisher are dedicated to
advancing education and support of
the antimicrobial stewardship
movement so that we may preserve
the effectiveness of existing
antibiotics both in the U.S. and
abroad. “
“Although antibiotics have been used to treat patients for
more than seven decades, we are now experiencing an
alarming emergence of antibiotic resistance. The relative
decline of new and novel antibiotics being introduced for
treating infections over the past two decades compounds
the precarious position that we now face.”
~Resistance: Policy Recommendations to Save Lives
QoL

12. Grace Medical is partnered with Diatherix Eurofins, a molecular diagnostic laboratory that
specializes in the diagnosis of infectious diseases. Their state of the art laboratory and R&D
division are located inside the HudsonAlpha Institute of Biotechnology, Huntsville, AL.
We provide solutions to aide your antibiotic stewardship and infectious disease control &
prevention programs. Our technology offers reporting that directly correlates to:
• Improved patient quality of life
• Reduced re-admissions
• Control & often prevention of HAIs
• Lowered, with potential to eliminate the
overuse and misuse of antibiotics
• Increased quality measures for improved star ratings
Diatherix Rapid Molecular DiagnosticsQoL

13. The Advantages of Molecular Diagnostics (MDx)
We provide a menu of molecular diagnostic panels that produce an actionable
treatment plan. Each panel, when paired with the antibiotic resistant panel (ABRx) ,
will provide physicians guidance as to proper antibiotic administration, thereby
improving therapeutic response and patient recovery time.
Advantages of MDx vs Culture:
• Next day reporting
• ABRx Panel provides guidance for appropriate antibiotic treatment
• Offers simplicity of single sample collection
• Ability to detect bacteria in the presence of an antibiotic
• Identifies difficult to culture Pathogens
QoL

14. • TEM-PCR™ technology is capable of
identifying bacteria, regardless of recent
antibiotic use
• Reduced antibiotic utilization and
inappropriate prescribing
• Identifies difficult to culture pathogens
• Improved patient outcomes
• Offers simplicity of single sample
collection
• Yields greater than 95% analytical
sensitivity and specificity
QoL

15. Commonly used panels in the LTCF Environment
PANEL PURPOSE (indications)
Antibiotic Resistance (ABRx™) Detection results can be used to define an
antibiotic class avoidance strategy
Respiratory (RPP) Bronchitis, Common Cold, Pharyngitis,
Sinusitis, Cough, Fever, Wheezing,
Pneumonia, Viral Infection
Skin and Soft Tissue (SSTI) Open Wound, Diabetic Foot, Bed Sores
Gastrointestinal (GI) Nausea with or without vomiting, Diarrhea,
Abdominal Pain, Fever, Blood in Stool,
Abnormal Loss of Weight, Colitis,
Gastroenteritis, Viral Enteritis
Urinary Tract Infection (UTI) Foul Smelling or Dark Urine, Frequent
Urination, Sense of Incomplete Bladder
Emptying, Blood in Urine, Fever, Pain in
Lower Abdominal Area, Sudden Change in
Behavior, Falls
QoL
*Complete 25+ panels available here

16. “The true meaning of life is to plant
trees, under whose shade you do not
expect to sit.”
- NELSON HENDERSON -
Enriching the Quality of Life of Our Seniors
Jeani Smith: 409.504.8032
Brian Milner: 903.360.9291
info@gracemedicalconsultants.com
Grace Medical Consultants
QoL