Antimicrobial consumption and impact of antimicrobial stewardship programmes in long-term care facilities

Falcone, Marco; Paul, Mical; Yahav, Dafna; Orlando, Gabriella; Tiseo, Giusy; Prendki, Virginie; Güerri‐Fernández, Robert; Gavazzi, G.; Mutters, Nico T.; Cookson, Barry; Marco, M Tinelli

doi:10.1016/j.cmi.2018.07.028

Cited by 42 publications

(43 citation statements)

References 64 publications

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“…Some countries, such as France, Germany, the Netherlands and Norway, reported the dissemination of national guidelines and Norway and the Netherlands reported that the guidelines were specific for the elderly patient population. The antimicrobial stewardship indicator data in this survey were comparable with that from previous similar surveys, which indicate that improvements in antimicrobial stewardship are urgently needed in LTCFs in the EU/EEA [ 16 , 27 ].…”

Section: Discussionsupporting

confidence: 79%

Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017

et al. 2018

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Antimicrobials are commonly prescribed and contribute to the development of antimicrobial resistance in long-term care facilities (LTCFs). In 2010, the European Centre for Disease Prevention and Control initiated point prevalence surveys (PPS) of healthcare-associated infections and antimicrobial use in European LTCFs, performed by external contractors as the Healthcare-Associated infections in Long-Term care facilities (HALT) projects. Here, we investigated prevalence and characteristics of antimicrobial use and antimicrobial stewardship indicators in European LTCFs in 2016–17. Twenty-four European Union/European Economic Area (EU/EEA) countries, the former Yugoslav Republic of Macedonia and Serbia participated in the third PPS in European LTCFs. Overall, 4.9% (95% confidence interval: 4.8–5.1) of LTCF residents in the EU/EEA participating countries received at least one antimicrobial. The most commonly reported Anatomical Therapeutic Chemical (ATC) groups were beta-lactam antibacterials/penicillins (J01C), other antibacterials (J01X) (e.g. glycopeptide antibacterials, polymyxins), quinolones (J01M), sulfonamides and trimethoprim (J01E), and other beta-lactams (J01D). Urinary tract infections and respiratory tract infections were the main indications for antimicrobial prescription. This PPS provides updated and detailed information on antimicrobial use in LTCFs across the EU/EEA that can be used to identify targets for future interventions, follow-up of these interventions and promote prudent use of antimicrobials in European LTCFs.

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Section: Discussionsupporting

confidence: 79%

Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017

et al. 2018

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“…Studies have estimated that between 47% and 70% of residents receive a course of antibiotics annually, and that between 77% to 88% of infections are treated with an antibiotic 7–9. Approximately 50% of these prescriptions are judged to be inappropriate,9 with inappropriate treatment of urinary tract infections and respiratory tract infections common in LTCF residents 7–12. Thus, there is considerable scope for improving antibiotic use in LTCFs.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Raban

Gasparini

et al. 2020

BMJ Open

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ObjectivesThere are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and CINAHL from 1997 until November 2018.Eligibility criteriaControlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations.Data extraction and synthesisTwo reviewers independently applied the Cochrane Effective Practice and Organisation of Care group’s resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results.ResultsOf include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers.ConclusionsThere is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.

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“…These antibiotics are considered as having higher toxicity and/or resistance potential, making them potential targets for antibiotic stewardship. 12,16 Prescriptions of second-line antibacterials, such as fluoroquinolones, or antibacterials not recommended in the guidelines for empirical antibacterial therapy, should be discussed in physician-pharmacist-nurse quality circles in order to promote the use of first-line antibacterials. Pharmacists in quality circles draw up yearly reports on antibacterial use that facilitate monitoring trends in use and determining the impact of interventions.…”

Section: Discussionmentioning

confidence: 99%

Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities

Plüss-Suard

Niquille

Héquet³

et al. 2020

Journal of the American Medical Directors Association

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Antimicrobial consumption and impact of antimicrobial stewardship programmes in long-term care facilities

Cited by 42 publications

References 64 publications

Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017

Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities

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