Katherine Ellingson, PhD, assistant professor of epidemiology at the University of Arizona Mel and Enid Zuckerman College of Public Health, received a three-year, $387,000 Arizona Biomedical Research Commission Investigator Grant, to develop an antibiotic stewardship program, or “playbook,” for prescribing antibiotics to treat infectious diseases in skilled nursing facilities in Arizona.

Antibiotic-resistant infections cause at least 2 million illnesses annually in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). The overprescribing of antibiotics is pervasive across health-care settings and contributes to the global crisis of antibiotic resistance. 

“Studies suggest that up to 75 percent of antibiotic prescribing in skilled nursing facilities is inappropriate, so there is a real opportunity to improve care and rein in antibiotic resistance in Arizona’s 164 facilities,” Dr. Ellingson said.

Skilled nursing facility residents are at heightened risk for acquiring antibiotic-resistant infections, including pathogens recently dubbed “nightmare bacteria” by the CDC. Residents are also at higher risk for antibiotic-associated adverse events like Clostridium difficile, commonly known as C. diff. Symptoms can range from diarrhea to a dangerous and potentially fatal inflammation of the colon. 

In 2016, the Centers for Medicare and Medicaid Services instituted a requirement for all U.S. skilled nursing facilities to implement an antibiotic stewardship program (ASP) by November 2017 as a condition of reimbursement. However, a recent survey found only a quarter of Arizona skilled nursing facilities reported any preparation for ASP implementation. 

This grant award is the result of an academic-community research partnership between Dr. Ellingson, community partners and Peter Patterson, MD, MBA, a subject-matter expert in antibiotic stewardship with Patterson LTC Consults. Dr. Patterson previously has led stewardship initiatives with national quality improvement organizations. He developed an antibiotic stewardship protocol for two Arizona facilities in 2015 that showed 50-percent reductions in antibiotic use and adverse events. 

”Our objective is to rigorously evaluate implementation of this protocol in 16 Arizona skilled nursing facilities with an eye toward developing a playbook for stewardship that can be feasibly implemented in these unique and resource-limited settings,” Dr. Ellingson said.