Failure to Follow Antibiotic Stewardship Program and Loeb's Criteria
Penalty
Summary
The facility failed to adhere to its Antibiotic Stewardship Program by administering antibiotics to six residents who did not meet the Loeb's criteria for initiating antibiotic therapy. In multiple cases, antibiotics were prescribed and administered based on symptoms that did not align with established clinical guidelines, such as confusion, knee pain, or abdominal pain, without the presence of fever, dysuria, or other specific signs of infection. Documentation revealed that antibiotics were started before culture results were available, and in some instances, the prescribed antibiotics were not effective against the identified microorganisms, as shown by culture results indicating resistance. For example, one resident with Alzheimer's disease and a history of UTI was given levofloxacin for suspected UTI despite only exhibiting knee pain and increased confusion, with no fever or urinary symptoms. Another resident with paralysis of the vocal cords and diabetes received levofloxacin for pharyngitis based solely on a fever and sore throat, without further documented assessment or additional symptoms. Additional residents received antibiotics for confusion, abdominal pain, or asymptomatic bacteriuria, again without meeting the minimum clinical criteria for antibiotic initiation. Interviews with the Infection Preventionist (IP) and review of records confirmed that the facility's antibiotic stewardship meetings were infrequent, and there was a lack of consistent interdisciplinary oversight. The IP acknowledged awareness of the inappropriate antibiotic use but deferred to physician decisions, and the medical director confirmed a practice of prescribing antibiotics preemptively while awaiting culture results. The facility's policy required adherence to evidence-based criteria and monitoring of antibiotic use, but these protocols were not consistently followed, as evidenced by the findings.