Massachusetts has demonstrated the feasibility of improving antibiotic prescribing practices in nursing homes through a statewide reporting program and collaborative interventions, according to a study published late last week in Clinical Infectious Diseases. The program, launched in 2018 by the Massachusetts Department of Health in partnership with Tufts Medical Center, established a standardized system for tracking the initiation of antibiotic use in long-term care facilities.
Antibiotics are frequently administered in nursing homes, with over half of residents receiving at least one course annually. However, research indicates that a substantial proportion – up to 75% – of these prescriptions are not clinically necessary. The Massachusetts initiative aimed to increase transparency in antibiotic use and guide quality improvement efforts through benchmarking.
The program utilized an online platform to collect data on antibiotic starts from 217 facilities between 2018 and 2024. Participation grew from 18.8% to 24.2% of all long-term care facilities in the state during the study period, with a median of 53 facilities reporting data each month. The rate of antibiotic starts increased by 7%, rising from 7.22 to 7.70 starts per 1,000 resident-days.
Penicillin/beta-lactamase inhibitors, first- and third-generation cephalosporins, fluoroquinolones and tetracycline accounted for 62.7% of all antibiotics initiated. An analysis of the data revealed a 36% decrease in fluoroquinolone prescriptions over the study period, coupled with a 26% increase in beta-lactam prescriptions. Researchers characterized this shift as aligning with intended stewardship goals, promoting safer and more guideline-concordant prescribing.
The study authors noted that the increase in overall antibiotic starts could be attributed to changes in the composition of participating facilities. However, they emphasized that the decline in fluoroquinolone use and the concurrent rise in beta-lactam prescribing suggest a positive impact on antibiotic stewardship practices.
“the Massachusetts Antibiotic Start Reporting Program demonstrates that antimicrobial stewardship in LTC is feasible through sustained public health-academic collaboration and a multicomponent approach,” the authors concluded. “Its success derives from the combined impact of benchmarking, feedback, education, and recognition implemented over time, rather than from any single discrete intervention.”
The program’s success comes as Massachusetts health leadership continues to have strong ties to Tufts University. According to reporting from Tufts Now, two key figures in Massachusetts health policy have connections to the university.
A separate study published in Nature highlights the importance of utilizing both hospital and community-based virologic test data for nowcasting epidemic trends, a practice that could complement antibiotic stewardship efforts by providing more accurate assessments of infectious disease outbreaks.
The Massachusetts program’s findings arrive amid a surge in flu cases across the state, with the Massachusetts Department of Public Health reporting the fourth influenza-related pediatric death of the current season, according to NBC Boston.
