Hospital patients who are discharged to a skilled nursing facility are routinely prescribed antibiotics that often put them at a high risk for subsequent Clostridium difficile infections, according to a study published in JAMA Network Open. Nursing home residents already are at a heightened risk for antibiotic-associated adverse events due to a convergence of risk factors.

The study analyzed data of patients prescribed antibiotics during their hospitalization and then followed them through post-acute nursing stays. Nearly two-thirds of the residents received antibiotics during their care, with the majority initiated during hospitalization. Of the prescribed antibiotics, 64 percent were considered high-risk as defined by the World Health Organization’s AWARE categorization system, a set of guidelines designed to slow the development of antibiotic resistance.

Exposure to antibiotics was associated with rehospitalization and infection with C. diff, a bacterium that afflicts 200,000 people per year in health care settings, causing diarrhea, gut pain, and other intestinal issues. Patients who received antibiotics also tended to have rooms contaminated with multidrug-resistant organisms or vancomycin-resistant enterococci (germs that can no longer be killed with vancomycin, a drug typically used to treat C. diff) when compared with those who did not receive antibiotics.

The study demonstrates an opportunity to better coordinate hospital antimicrobial stewardship programs with nursing home practices to reduce rates of C. diff infection, colonization by resistant pathogens, and high-risk antibiotic prescribing.

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