(P70) Loeb Criteria via Telemedicine: Assessing for Infection in LTCF Residents

Introduction/

Objective: Pneumonia and urinary tract infections (UTI) are two of the most common diagnoses of residents of long-term care facilities (LTCF), accounting for over 40% of antibiotic use. However, studies have repeatedly shown much of the antibiotic prescribing to be unnecessary. The Loeb criteria, a tool for antibiotic stewardship, is an established minimum set of signs and symptoms to be met for initiation of antibiotics in LTCF residents. This criteria has been shown to be effective in decreasing unnecessary antibiotic use, without increasing hospitalizations or mortality. The expansion of telemedicine with the COVID-19 pandemic has shown potential for improving clinical outcomes for LTCF residents. We performed a review of the literature to determine if there is evidence to support use of telemedicine as a tool to apply the Loeb criteria in making the decision to initiate antibiotics for pneumonia and UTI in LTCF residents.

Design/Methodology: We conducted a PubMed search using the following terms: ((telemedicine OR telehealth* OR tele‐health* OR telecare OR tele-care OR Telemedicine[majr]) AND (((((cross infection) OR (nosocomial infection)) OR (community-acquired-infections)) OR (infectious disease transmission)) OR (urinary tract infection)) OR (pneumonia)) AND ((((long term care facilit*) OR (homes for the aged)) OR (nursing homes)) OR (long term care)). We also performed a separate search using the terms ("telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR "telemedicine s"[All Fields]) AND ("physical examination"[MeSH Terms] OR ("physical"[All Fields] AND "examination"[All Fields]) OR "physical examination"[All Fields] OR ("physical"[All Fields] AND "exam"[All Fields]) OR "physical exam"[All Fields]). Results were filtered by “English language” and “Human” and there were no restrictions on publication date.

Results: Our search found five publications detailing best practices for physical exam via telemedicine for application of Loeb minimum criteria. Four of the five studies show that the criteria for pneumonia can be appropriately assessed via telemedicine; specifically tachypnea, tachycardia, and cough. Two of the five studies show that the criteria for UTI can be appropriately assessed via telemedicine; specifically dysuria, urgency, frequency, hematuria, new incontinence, costovertebral angle tenderness, and suprapubic pain. All five studies show that aspects of the Loeb criteria for both pneumonia and UTI, specifically fever, rigors, and delirium, can also be assessed via telemedicine.

Conclusion/

Discussion: Our review of the literature supports use of telemedicine for application of Loeb criteria to assist in appropriate antibiotic treatment of pneumonia and UTI in LTCF residents. Telemedicine provides virtual opportunities for comprehensive clinical assessment and appropriate treatment of residents, and can be a tool for antibiotic stewardship. Further studies are needed to more fully assess if application of this criterion via telemedicine can improve clinical outcomes for LTCF residents.