{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T22:26:13Z","timestamp":1768343173555,"version":"3.49.0"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T00:00:00Z","timestamp":1567036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2020,1]]},"abstract":"\n OBJECTIVES<\/jats:title>\n To derive weighted\u2010incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use.<\/jats:p>\n <\/jats:sec>\n \n DESIGN<\/jats:title>\n Retrospective analysis of microbial data from a regional laboratory.<\/jats:p>\n <\/jats:sec>\n \n SETTING<\/jats:title>\n We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015.<\/jats:p>\n <\/jats:sec>\n \n PARTICIPANTS<\/jats:title>\n A total of 28 regional SNFs (rSNFs) and 7 in\u2010network SNFs (iSNFs).<\/jats:p>\n <\/jats:sec>\n \n MEASUREMENTS<\/jats:title>\n \n WISCAs were derived combining\n Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae<\/jats:italic>\n , and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim\/sulfamethoxazole.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11\u2010113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76\u201011.77;\n P\u2009=<\/jats:italic>\n .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I\n 2<\/jats:sup>\n = 93.33;\n P<\/jats:italic>\n \u2009<\u2009.01). Susceptibilities to cefazolin (95% vs 76%;\n P<\/jats:italic>\n \u2009<\u2009.001) and fluoroquinolones (72% vs 64%;\n P<\/jats:italic>\n = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n \n These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs.\n J Am Geriatr Soc 68:55\u201361, 2019<\/jats:bold>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.16134","type":"journal-article","created":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T04:14:52Z","timestamp":1567052092000},"page":"55-61","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility"],"prefix":"10.1111","volume":"68","author":[{"given":"Claire","family":"Davenport","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Albany New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Brodeur","sequence":"additional","affiliation":[{"name":"Albany College of Pharmacy and Health Sciences Albany New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Wolff","sequence":"additional","affiliation":[{"name":"Albany Medical College Albany New York"},{"name":"The Eddy Foundation, St. Peter's Health Partners Albany New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick D.","family":"Meek","sequence":"additional","affiliation":[{"name":"Albany College of Pharmacy and Health Sciences Albany New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"Crnich","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Wisconsin Madison Wisconsin"},{"name":"William S. Middleton Veterans Affairs Hospital Madison Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,29]]},"reference":[{"issue":"4","key":"e_1_2_6_2_1","first-page":"33","article-title":"Urinary tract infections in older adults residing in long\u2010term care facilities","volume":"20","author":"Genao L","year":"2012","journal-title":"Ann Longterm Care."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/29.4.297"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/677818"},{"key":"e_1_2_6_5_1","volume-title":"Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies","author":"Ranji SR","year":"2006"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-2-17"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.50.7s.3.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr395"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2014.01.001"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1086\/595683"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1703058"},{"key":"e_1_2_6_12_1","unstructured":"UnroeK OttM LiebK CarterJ PattenD. Managing infections in the nursing home: lessons from the OPTIMISTIC demonstration project. Paper presented at: American Geriatrics Society 2019 Annual Scientific Meeting; May 2019; Portland OR."},{"key":"e_1_2_6_13_1","unstructured":"The Core Elements of Antibiotic Stewardship for Nursing Homes. Centers for Disease Control and Prevention: Division of Healthcare Quality Promotion.http:\/\/www.cdc.gov\/longtermcare\/prevention\/antibiotic-stewardship.html. 2016. Accessed May 2019."},{"issue":"10","key":"e_1_2_6_14_1","first-page":"18","article-title":"Implementing an antimicrobial stewardship program","volume":"31","author":"Martin CM","year":"2016","journal-title":"Consult Pharm"},{"key":"e_1_2_6_15_1","first-page":"165","article-title":"Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives","volume":"9","author":"Lim CJ","year":"2014","journal-title":"Clin Interv Aging."},{"issue":"5","key":"e_1_2_6_16_1","first-page":"324","article-title":"Optimizing antibiotic use in nursing homes through antibiotic stewardship","volume":"77","author":"Sloane PD","year":"2016","journal-title":"N C Med J."},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266-015-0292-7"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2014.09.005"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/2047-2994-3-6"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1086\/650446"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000135"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2017.07.018"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1086\/511864"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2013.02.009"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1086\/664768"},{"issue":"469","key":"e_1_2_6_26_1","article-title":"Patient\u2010based stratification of weighted\u2010incidence syndromic antibiogram (WISCA) for empiric antibiotic prescribing","volume":"5","author":"Hebert C","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.2012.01163.x"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2013.11.004"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2009.04.005"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1086\/647981"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0086634"},{"issue":"7","key":"e_1_2_6_32_1","first-page":"771","article-title":"Diagnosis and treatment of acute uncomplicated cystitis","volume":"84","author":"Colgan R","year":"2011","journal-title":"Am Fam Physician."},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-018-0909-x"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016006376.x"},{"issue":"10","key":"e_1_2_6_35_1","first-page":"17","article-title":"An innovative quality assurance activity to reduce urinary tract infection rates in green house skilled nursing setting","volume":"24","author":"Wolff ML","year":"2016","journal-title":"Ann Longterm Care"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X0800800102"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2006.03.034"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.115.2.462"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.118.1.146"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3182489cc4"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/2050-6511-15-51"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2018.05.006"},{"key":"e_1_2_6_44_1","unstructured":"HirshonJM ComerA RosenbergJH JohnsonJK MooreSL MacKenzieTD HallKK FurunoJP. Methodological challenges associated with developing and implementing antibiograms in nursing homes. Agency for Healthcare Research and Quality.http:\/\/www.ahrq.gov\/professionals\/quality-patient-safety\/patient-safety-resources\/resources\/advances-in-hai\/hai-article9.html. 2014. Accessed May 2019."}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.16134","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16134","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.16134","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.16134","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:49:08Z","timestamp":1762184948000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.16134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,29]]},"references-count":43,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1111\/jgs.16134"],"URL":"https:\/\/doi.org\/10.1111\/jgs.16134","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,29]]},"assertion":[{"value":"2019-06-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}