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Objectives To describe the prevalence and epidemiology of antimicrobial use (AU) in nursing home residents. Design One-day point prevalence survey. Setting and participants Nine nursing homes in four states; 1,272 eligible residents. Measurement Frequency of antimicrobials prescribed, drug name, start date, duration, route, rationale, and treatment site. AU prevalence per 100 residents overall and by resident characteristic. Results AU prevalence was 11.1% (95% confidence interval, 9.4%–12.9%) and varied by resident characteristics. Most (32%) antimicrobials were given for urinary tract infection. For 38% of AU, key prescribing information was not documented. Conclusion Opportunities to improve AU documentation and prescribing exist in nursing homes.

Previous work has suggested that central-line-associated bloodstream infection (CLABSI) is associated with increased costs and risk of mortality; however, no studies have looked at both total and variable costs, and information on outcomes outside of the intensive-care unit (ICU) is sparse. The aim of this study was to determine the excess in-hospital mortality and costs attributable to CLABSI in ICU and non-ICU patients. We conducted a retrospective cohort and cost-of-illness study from the hospital perspective of 398 patients at a tertiary-care academic medical centre from 1 January 2008 to 31 December 2010. All CLABSI patients and a simple random sample drawn from a list of all central lines inserted during the study period were included. Generalized linear models with log link and gamma distribution were used to model costs as a function of CLABSI and important covariates. Costs were adjusted to 2010 US dollars by use of the personal consumption expenditures for medical care index. We used multivariable logistic regression to identify independent predictors of in-hospital mortality. Among both ICU and non-ICU patients, adjusted variable costs for patients with CLABSI were c. $32 000 (2010 US dollars) higher on average than for patients without CLABSI. After we controlled for severity of illness and other healthcare-associated infections, CLABSI was associated with a 2.27-fold (95% CI 1.15–4.46) increased risk of mortality. Other healthcare-associated infections were also significantly associated with greater costs and mortality. Overall, CLABSI was associated with significantly higher adjusted in-hospital mortality and total and variable costs than those for patients without CLABSI.