Antibiotic Use and Resistance in Long Term Care Facilities

Buul, Laura W van; Steen, Jenny T. van der; Veenhuizen, Ruth B.; Achterberg, Wilco P.; Schellevis, François G.; Essink, R.T.G.M.; Benthem, B.H.B. van; Natsch, Stephanie; Hertogh, Cees M.P.M.

doi:10.1016/j.jamda.2012.04.004

Cited by 187 publications

(165 citation statements)

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“…The available data show a high prevalence of infections in nursing homes, accompanied by high mortality rates, repeated stays in the hospital, and high prevalence of colonization with multiresistant bacteria. 2,3 Hence, infection control in nursing homes is a real public health concern, with important associated economic and health costs. 3 Although there are published guidelines for infection prevention and control in nursing homes, 4 control measures and effective prevention remain largely inadequate.…”

mentioning

confidence: 99%

Impact of hand hygiene on the infectious risk in nursing home residents: A systematic review

Hocine

Temime

2015

American Journal of Infection Control

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confidence: 99%

Impact of hand hygiene on the infectious risk in nursing home residents: A systematic review

Hocine

Temime

2015

American Journal of Infection Control

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“…79,80 The rate of C. difficile infection in England was approximately 366.9 per 100,000 in 2011 for people aged over 65 years, while the same rate was approximately 42.5 for those under 65 years of age. 7 This indicates that C. difficile is still an issue of concern for the specific age group, even though there was a 53% decrease in overall numbers of reported cases between 2008 and 2011. 8 The qualitative study on consent issues…”

Section: Comparisons To Existing Researchmentioning

confidence: 99%

“…5,6 This antibiotic use has consequences for residents' quality of life (QoL) from both benefits and harms associated with antibiotic use, costs of care and increased risk that subsequent infections will be antibiotic resistant. [7][8][9] However, up to 40% of antibiotics prescribed in care homes might be inappropriate. [8][9][10] Accurate estimates of prescription rates by antibiotic class and indication are lacking.…”

Section: Antibiotic Use In Care Homesmentioning

confidence: 99%

Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes

Hood

Nuttall

Gillespie

et al. 2014

Health Technology Assessment

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BackgroundAntibiotic prescribing rates in care homes are higher than in the general population. Antibiotics disrupt the normal gut flora, sometimes causing antibiotic-associated diarrhoea (AAD).Clostridium difficile(Hall and O’Toole 1935) Prévot 1938 is the most commonly identified cause of AAD. Little is known either about the frequency or type of antibiotics prescribed in care homes or about the incidence and aetiology of AAD in this setting.ObjectivesThe Probiotics for Antibiotic-Associated Diarrhoea (PAAD) study was designed as a two-stage study. PAAD stage 1 aimed to (1) prospectively describe antibiotic prescribing in care homes; (2) determine the incidence ofC. difficilecarriage and AAD (includingC. difficile-associated diarrhoea); and (3) to consider implementation challenges and establish the basis for a sample size estimation for a randomised controlled trial (RCT) of probiotic administration with antibiotics to prevent AAD in care homes. If justified by PAAD stage 1, the RCT would be implemented in PAAD stage 2. However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2.DesignPAAD stage 1 was a prospective observational cohort study in care homes in South Wales with up to 12 months’ follow-up for each resident.SettingRecruited care homes had management and owner’s agreement to participate and three or more staff willing to take responsibility for implementing the study.ParticipantsEleven care homes were recruited, but one withdrew before any residents were recruited. A total of 279 care home residents were recruited to the observational study and 19 withdrew, 16 (84%) because of moving to a non-participating care home.Main outcome measuresThe primary outcomes were the rate of antibiotic prescribing, incidence of AAD, defined as three or more loose stools (type 5–7 on the Bristol Stool Chart) in a 24-hour period, andC. difficilecarriage confirmed on stool culture.ResultsStool samples were obtained at study entry from 81% of participating residents. Over half of the samples contained antibiotic-resistant isolates, with Enterobacteriaceae resistant to ciprofloxacin in 47%. Residents were prescribed an average of 2.16 antibiotic prescriptions per year [95% confidence interval (CI) 1.90 to 2.46]. Antibiotics were less likely to be prescribed to residents from dual-registered homes. The incidence of AAD was 0.57 (95% CI 0.41 to 0.81) episodes per year among those residents who were prescribed antibiotics. AAD was more likely in residents who were prescribed co-amoxiclav than other antibiotics and in those residents who routinely used incontinence pads. AAD was less common in residents from residential homes.ConclusionsCare home residents, particularly in nursing homes, are frequently prescribed antibiotics and often experience AAD. Antibiotic resistance, including ciprofloxacin resistance, is common in Enterobacteriaceae isolated from the stool of care home residents. Co-amoxiclav is associated with greater risk of AAD than other commonly prescribed antibiotics.Trial registrationCurrent Controlled Trials ISRCTN 7954844.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 63. See the NIHR Journals Library website for further project information.

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“…In these guidelines, HRMOs are defined as 'microorganisms that are known to cause human disease, have acquired an antimicrobial resistance pattern that hampers (empirical) therapy, and have the potential to spread in healthcare facilities if-in addition to standard precautions-no transmission-based precautions are taken'. Since antimicrobial use is considered one of the most important factors selecting for antimicrobial resistance, 4 the aim should be to optimize the use of antimicrobials. Emergence of HRMOs in a low-endemic population may result in a reservoir from which transmission can occur, with potential consequences for vulnerable populations.…”

Section: Introductionmentioning

confidence: 99%

Carriage of antimicrobial-resistant commensal bacteria in Dutch long-term-care facilities

Verhoef

Roukens

Greeff

et al. 2016

J. Antimicrob. Chemother.

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Objectives: The objective of this study was to assess carriage of antimicrobial-resistant commensal microorganisms, i.e. Escherichia coli and Staphylococcus aureus, and its predictors in long-term-care facilities (LTCFs).Methods: Nasal swabs and/or urine or incontinence samples were collected from participating residents in 111 LTCFs and tested for the presence of S. aureus and/or E. coli, respectively. Antimicrobial resistance to eight antimicrobials was linked to antimicrobial usage in the year preceding sampling and to LTCF characteristics. Using multilevel logistic regression, predictors of carriage of ESBL-producing E. coli in LTCFs were identified.Results: S. aureus was identified in 1269/4763 (26.6%) nasal swabs, including 13/4763 (0.3%) MRSA carriers in 9/107 (8%) LTCFs. Of the 5359 urine/incontinence samples, 2934 (55%) yielded E. coli, including 123 (4.2%) producing ESBL, which were found in 53/107 locations (range 1% -33%). For all but one antimicrobial (i.e. nitrofurantoin) .20% of isolated E. coli were resistant. Multilevel multivariable logistic regression identified two predictors of carriage of ESBL-producing E. coli: (i) antimicrobial usage (OR 1.8, 95% CI 1.1 -3.0 for each extra 50 DDD/1000 residents/day); and (ii) presence of MRSA carriers in the LTCFs (OR 2.4, 95% CI 1.0-5.6). Conclusions:The low proportion of 4.2% ESBL-producing E. coli and the low prevalence of 0.3% MRSA carriage found in LTCF residents suggest that Dutch LTCFs are not yet an important reservoir of MDR potential pathogens. Nevertheless, the large variation between LTCFs warrants close monitoring of antimicrobial resistance in LTCFs.

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Antibiotic Use and Resistance in Long Term Care Facilities

Abstract: The findings of this review call for the conduction of research and the development of policies directed at reducing antibiotic resistance and its subsequent burden for long term care facilities and their residents.

Cited by 187 publications

References 155 publications

Impact of hand hygiene on the infectious risk in nursing home residents: A systematic review

Impact of hand hygiene on the infectious risk in nursing home residents: A systematic review

Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes

Carriage of antimicrobial-resistant commensal bacteria in Dutch long-term-care facilities

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