Antibiotic use and misuse in residential aged care facilities

Stuart, Rhonda L.; Wilson, Jill; Bellaard-Smith, Elizabeth R.; Brown, Richard E.; Wright, Louise; Vandergraaf, Susan; Gillespie, Elizabeth

doi:10.1111/j.1445-5994.2012.02796.x

Cited by 55 publications

(40 citation statements)

References 14 publications

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“…Older residents often have complicating comorbidities, blunted fever responses, or vague systemic symptoms which make definitive diagnosis problematic [10, 36**, 37, 38]. The most common infection leading to inappropriate antibiotic therapy is urinary tract infection, which accounts for 30–56% of antibiotics prescribed, with up to one third of these prescriptions for residents with asymptomatic bacteriuria [39].…”

Section: Antibiotic Stewardshipmentioning

confidence: 99%

Healthcare-associated infections in the elderly: what's new

Katz

Roghmann

2016

Current Opinion in Infectious Diseases

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Purpose of review The high risk population and current lack of knowledge regarding appropriate infection prevention in the long-term care setting has contributed to substantial rates of resistance and healthcare-associated infections in this arena. More evidence-based research on long-term care is necessary, particularly now that the elderly population is increasing. Recent findings Proposed government mandates highlight the urgent need to combat antimicrobial resistance in the long-term care setting. Recent studies focusing on unique strategies for the prevention of transmission and infection with multi drug resistant organisms in nursing homes are discussed, as well as attempts to formulate clear antimicrobial stewardship programs. Summary The long-term setting has unique challenges to instituting effective infection control precautions, therefore current accepted methods used in acute-care facilities need to be modified. Recent data suggest that prevention of transmission in long-term care (LTC) may be achieved with focus on high-risk patients or specific care-based activities rather than colonization status. Antimicrobial stewardship and consultation with specialized physicians may be important measures to combat resistance and adverse events in LTC. The prevention of unnecessary antibiotic use in palliative care may reduce rates of resistance as well as discomfort for terminal patients.

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Section: Antibiotic Stewardshipmentioning

confidence: 99%

Healthcare-associated infections in the elderly: what's new

Katz

Roghmann

2016

Current Opinion in Infectious Diseases

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“…Antibiotics are among the most commonly prescribed classes of medications for LTCF residents [4]. Between 3% and 15% of LTCF residents are given antibiotics at any time according to point prevalence studies in Europe, USA and Australia [5][6][7]. The incidence of antibiotic use varies considerably, with 50-80% of residents receiving at least an antibiotic course per year [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.

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“…We also did not consider the 1% of HAIs treated with two or more antibiotics in the same class as inappropriate. These limitations may account, in part, for the higher level of appropriateness found in this study (85%) compared to studies in adult LTC (49–79%) which used different definitions of appropriateness [13, 17–19]. In addition, 30% of antibiotic-treated HAIs for which diagnostic testing was available had only viral pathogens identified.…”

Section: Discussionmentioning

confidence: 66%

Use of antibiotics in paediatric long-term care facilities

Murray

Johnson

Cohen

et al. 2018

Journal of Hospital Infection

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STRUCTURED SUMMARY Background Adult long term care (LTC) have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC. Aim We sought to describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. Methods A retrospective cohort study was conducted September 2012 – December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAI), antimicrobial use, and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi square. Findings Fifty-eight percent (413/717) of residents had at least one HAI, 79% (325/413) of whom were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurologic disorder, having a tracheostomy, and being hospitalised at least once during the study were significantly associated with receiving antibiotics when controlling for facility (all p <0.001). Diagnostic testing was performed for 40% of antibiotic-treated HAI. Eighty-six percent of antibiotic courses for identified bacterial pathogens (n=201/233) provided appropriate coverage. Having access to susceptibility testing was not associated with appropriate antibiotic choice. (p=0.26). Conclusion Use of antibiotics in paediatric LTC facilities is widespread. There is further need to assess antibiotic use in paediatric LTC. Evaluation of the adverse outcomes associated with inappropriate antibiotic use including the prevalence of resistant organisms in paediatric LTC facilities is critical.

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Antibiotic use and misuse in residential aged care facilities

Abstract: Background: The prevention and control of transmission of antimicrobial-resistant

Cited by 55 publications

References 14 publications

Healthcare-associated infections in the elderly: what's new

Healthcare-associated infections in the elderly: what's new

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Use of antibiotics in paediatric long-term care facilities

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