Focusing on antibiotic utilization practices is a vital strategy to minimize the increasing incidence of both multidrug-resistant organisms (MDROs) and Clostridium difficile infections. Pennsylvania Patient Safety Authority staff analyzed the incidence of MDROs and C. difficile in Pennsylvania hospitals and long-term care facilities (LTCFs), identified antibiotic prescribing practices in LTCFs, and researched strategies to help healthcare facilities build or enhance antibiotic stewardship. From April 2014 through March 2015, 19.0% of the total healthcare-associated infections in Pennsylvania were caused by MDROs, and 17.1% by C. difficile. Over the same time period, 1.9% of infections in LTCFs were associated with MDROs, and 7.3% with C. difficile. Analysis of Pennsylvania's LTCF infection events identified frequent use of fluoroquinolones and cephalosporins as initial antibiotics in multiple infection categories. A review of the literature revealed detailed strategies, including engaging physicians and senior leadership, developing and using an antibiogram, and providing education to healthcare workers to address identified practice gaps and barriers. Implementing these strategies will promote appropriate antibiotic use and help facilities develop and sustain a robust stewardship program to decrease the incidence of MDRO and C. difficile infections.
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