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

Abstract

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.

Antimicrobials in acute and long-term care: a point in time along the way to improved use

“…Benchmarking use within and across facilities is helpful in identifying where action is needed. Antimicrobial use point prevalence surveys (PPS) complement the aggregate metrics by providing information on patient-level use, such as indication and site of infection during the specified time period [ 3 , 4 ]. This approach is able to reveal more targeted quality improvements and enables comparisons of antimicrobial use at the national, regional or local level.…”

Antibiotic Stewardship in European Nursing Homes: Experiences From the Netherlands, Norway, Poland, and Sweden

“…The Netherlands, Norway, and Sweden are some of the few European countries that have a national surveillance system for antibiotic prescribing that also includes data from NHs, albeit with challenges regarding the analysis and interpretability of these data. 4 For the establishment of a national surveillance system, a nationally representative sample of NHs from which data can be reliably collected is required. To this end, it is important to motivate participating NHs, for example by providing adequate and timely feedback to the antibiotic prescribers.…”

“…Whereas such NH specific guidelines exist in the Netherlands and Norway, they have not yet been developed in most European countries, as demonstrated by the recent ECDC survey of healthcareassociated infections and antimicrobial use in European LTCFs. 4 Antibiotic resistant bacteria cross the boundaries of individual healthcare institutions, sectors, and nations, which underlines the importance of collaboration at all these levels. The current article describes some forms of interinstitutional collaboration.…”

“…For example, where we found comparable organization of NH care in the selected countries, we know from European studies that there are large differences in Europe regarding what is considered long-term care, which translates into case-mix differences and comparability issues between countries. 4,6 Regarding these differences, a call for more standardized surveillance, definitions, and methods between countries was recently made by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in the Elderly (ESGIE). 6 Worldwide, transitions in healthcare are occurring or are about to occur as a result of population aging and demographic transition toward older persons.…”

“…The most recent survey reported a mean prevalence of 4.9% of antibiotic use among European countries. 4 Prevalences for the Netherlands (57 NHs), Norway (62 NHs), Poland (24 NHs), and Sweden (259 NHs) were 4.4%, 6.9%, 3.2%, and 3.3%, respectively. Table 2 describes other available national data on antibiotic prescribing (eg, national point-prevalence studies, amounts of antibiotics prescribed per 1000 resident-care days, studies on appropriateness of antibiotic use) and resistance for these 4 countries.…”