Background
Antimicrobials need to be prescribed appropriately and used optimally to minimize the propagation of multidrug-resistant pathogens. Few studies have explored the appropriate use of antimicrobials in long-term care wards for patients with advanced neuromuscular disorders or severe motor and intellectual disabilities. This study aimed to investigate the pathological conditions requiring antimicrobials in long-term care wards based on antimicrobial stewardship guidelines.
Methods
We retrospectively collected data from the electronic medical records of patients with advanced neuromuscular disorders or severe motor and intellectual disabilities who were administered intravenous (IV) medications between January 1, 2018, and December 31, 2020. We compared the usual medical treatment between January 1, 2018, and June 30, 2019 (usual treatment group) and treatment based on the principles of antimicrobial stewardship between July 1, 2019, and December 31, 2020 (optimal treatment group).
Results
We analyzed data from 65 patients (23 women [35.4%] and 42 men [64.6%]) with a median age of 38 (range, 8–62) years, and a median hospitalization period of 12 years (range, 1 month to 50 years) at the start of the study. A total of 205 IV infusion treatments were administered, 85 (41.5%) in the usual treatment group and 120 (58.5%) in the optimal treatment group, of which 32 (37.2%) and 28 (23.3%) involved antimicrobial treatment, respectively (p = 0.026). A significant difference was observed in the site of infection and the diagnosis of aspiration and respiratory tract infections, including pneumonia (p = 0.004). Moreover, we determined the relevance of peak C-reactive protein (CRP) levels during the treatment.
Conclusion
Evaluating the requirement for antibiotics by combining patient conditions and CRP levels may help to reduce the inappropriate use of antimicrobials in long-term care wards.