Antibiotic Use in Long-Term–Care Facilities: Many Unanswered Questions

AbstractThe extensive use of antibiotics in long-term–care facilities has led to increasing concern about the potential for the development of antibiotic resistance. Relatively little is known, however, about the quantitative relation between antibiotic use and resistance in this population. A better understanding of the underlying factors that account for variance in antibiotic use, unexplained by detected infections, is needed. To optimize antibiotic use, evidence-based standards for empirical antibiotic prescribing need to be developed. Limitations in current diagnostic testing for infection in residents of long-term–care facilities pose a substantial challenge to developing such standards.

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Antimicrobial prescribing in long-term care facilities: a nationwide point-prevalence study, Slovenia, 2016

Eurosurveillance ◽

10.2807/1560-7917.es.2018.23.46.1800100 ◽

2018 ◽

Vol 23 (46) ◽

Cited By ~ 2

Author(s):

Dora Stepan ◽

Lea Ušaj ◽

Marija Petek Šter ◽

Marjetka Smolinger Galun ◽

Hermina Smole ◽

...

Keyword(s):

Long Term Care ◽

Antibiotic Use ◽

Point Prevalence ◽

Prevalence Study ◽

Resistant Bacteria ◽

Antibiotic Prescribing ◽

Term Care ◽

Point Prevalence Study ◽

Care Facilities

Residents in long-term care are at high risk of infections because of their old age and many related health problems that lead to frequent antibiotic prescribing. The aim of the study was to assess antibiotic use in Slovenian long-term care facilities (LTCFs). The point-prevalence study was conducted between April and June 2016. Online questionnaires were sent to all Slovenian LTCFs. Eighty (68.4%) of the 117 LTCFs contacted, caring for 13,032 residents (70.6% of all Slovenian LTCF residents), responded to the survey. On the day of the study, the mean antibiotic prevalence per LTCF was 2.4% (95% confidence interval: 1.94–2.66). Most (70.2%) of the residents taking antibiotics were female. Most residents were being treated for respiratory tract (42.7%) or urinary tract (33.3%) infections. Co-amoxiclav and fluoroquinolones were the most frequently prescribed antibiotics (41.0% and 22.3% respectively). Microbiological tests were performed for 5.2% of residents receiving antibiotics. Forty nine (19.8%) residents receiving antibiotics were colonised with multidrug-resistant bacteria (MDR). Antibiotic use in Slovenian LTCFs is not very high, but most prescribed antibiotics are broad-spectrum. Together with low use of microbiological testing and high prevalence of colonisation with MDR bacteria the situation is worrisome and warrants the introduction of antimicrobial stewardship interventions.

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Antibiotic prescribing for residents in long-term-care facilities across the UK

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz008 ◽

2019 ◽

Vol 74 (5) ◽

pp. 1447-1451 ◽

Cited By ~ 6

Author(s):

Tracey Thornley ◽

Diane Ashiru-Oredope ◽

Andrew Normington ◽

Elizabeth Beech ◽

Philip Howard

Keyword(s):

Long Term Care ◽

Antibiotic Use ◽

Vulnerable Population ◽

Antibiotic Prescribing ◽

Major Public Health Problem ◽

Term Care ◽

Data Set ◽

Care Facilities ◽

Tract Infections

Abstract Background Antimicrobial resistance (AMR) is a major public health problem. Elderly residents in long-term-care facilities (LTCFs) are frequently prescribed antibiotics, particularly for urinary tract infections. Optimizing appropriate antibiotic use in this vulnerable population requires close collaboration between NHS healthcare providers and LTCF providers. Objectives Our aim was to identify and quantify antibiotic prescribing in elderly residents in UK LTCFs. This is part of a wider programme of work to understand opportunities for pharmacy teams in the community to support residents and carers. Methods This was a retrospective longitudinal cohort study. Data were extracted from a national pharmacy chain database of prescriptions dispensed for elderly residents in UK LTCFs over 12 months (November 2016–October 2017). Results Data were analysed for 341536 residents in LTCFs across the four UK nations, from which a total of 544796 antibiotic prescriptions were dispensed for 167002 residents. The proportion of residents prescribed at least one antibiotic over the 12 month period varied by LTCF, by month and by country. Conclusions Whilst national data sets on antibiotic prescribing are available for hospitals and primary care, this is the first report on antibiotic prescribing for LTCF residents across all four UK nations, and the largest reported data set in this setting. Half of LTCF residents were prescribed at least one antibiotic over the 12 months, suggesting that there is an opportunity to optimize antibiotic use in this vulnerable population to minimize the risk of AMR and treatment failure. Pharmacy teams are well placed to support prudent antibiotic prescribing and improved antimicrobial stewardship in this population.

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Infections and use of antibiotics in residents of long-term care facilities in Hungary

Orvosi Hetilap ◽

10.1556/oh.2014.29876 ◽

2014 ◽

Vol 155 (23) ◽

pp. 911-917 ◽

Cited By ~ 1

Author(s):

Rita Szabó ◽

Karolina Böröcz

Keyword(s):

Urinary Tract ◽

Long Term Care ◽

Soft Tissues ◽

Good Practice ◽

Antibiotic Use ◽

Prevalence Survey ◽

Term Care ◽

Care Facilities ◽

Tract Infections

Introduction: Healthcare associated infections and antimicrobial use are common among residents of long-term care facilities. Faced to the lack of standardized data, the European Centre for Disease Prevention and Control funded a project with the aim of estimating prevalence of infections and antibiotic use in European long-term care facilities. Aim: The aim of the authors was to present the results of the European survey which were obtained in Hungary. Method: In Hungary, 91 long-term care facilities with 11,823 residents participated in the point-prevalence survey in May, 2013. Results: The prevalence of infections was 2.1%. Skin and soft tissues infections were the most frequent (36%), followed by infections of the respiratory (30%) and urinary tract (21%). Antimicrobials were mostly prescribed for urinary tract infections (40.3%), respiratory tract infections (38.4%) and skin and soft tissue infections (13.2%). The most common antimicrobials (97.5%) belonged to the ATC J01 class of “antibacterials for systemic use”. Conclusions: The results emphasise the need for a national guideline and education for good practice in long-term care facilities. Orv. Hetil., 2014, 155(23), 911–917.

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Design and Development of a Web-based Delirium Preventive Application for Long-term Care Facilities: A Methodological Study (Preprint)

10.2196/preprints.26092 ◽

2020 ◽

Author(s):

Kyoung Ja Moon ◽

Chang-Sik Son ◽

Jong-Ha Lee ◽

Mina Park

Keyword(s):

Risk Factors ◽

Long Term Care ◽

Cloud System ◽

Evidence Based ◽

Methodological Study ◽

Term Care ◽

Web Based ◽

Care Facilities ◽

Delirium Prevention

BACKGROUND Long-term care facilities demonstrate low levels of knowledge and care for patients with delirium and are often not properly equipped with an electronic medical record system, thereby hindering systematic approaches to delirium monitoring. OBJECTIVE This study aims to develop a web-based delirium preventive application (app), with an integrated predictive model, for long-term care (LTC) facilities using artificial intelligence (AI). METHODS This methodological study was conducted to develop an app and link it with the Amazon cloud system. The app was developed based on an evidence-based literature review and the validity of the AI prediction model algorithm. Participants comprised 206 persons admitted to LTC facilities. The app was developed in 5 phases. First, through a review of evidence-based literature, risk factors for predicting delirium and non-pharmaceutical contents for preventive intervention were identified. Second, the app, consisting of several screens, was designed; this involved providing basic information, predicting the onset of delirium according to risk factors, assessing delirium, and intervening for prevention. Third, based on the existing data, predictive analysis was performed, and the algorithm developed through this was calculated at the site linked to the web through the Amazon cloud system and sent back to the app. Fourth, a pilot test using the developed app was conducted with 33 patients. Fifth, the app was finalized. RESULTS We developed the Web_DeliPREVENT_4LCF for patients of LTC facilities. This app provides information on delirium, inputs risk factors, predicts and informs the degree of delirium risk, and enables delirium measurement or delirium prevention interventions to be immediately implemented with a verified tool. CONCLUSIONS This web-based application is evidence-based and offers easy mobilization and care to patients with delirium in LTC facilities. Therefore, the use of this app improves the unrecognized of delirium and predicts the degree of delirium risk, thereby helping initiatives for delirium prevention and providing interventions. This would ultimately improve patient safety and quality of care. CLINICALTRIAL none

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Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

BMC Geriatrics ◽

10.1186/1471-2318-14-136 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 33

Author(s):

Laura W van Buul ◽

Jenny T van der Steen ◽

Sarah MMM Doncker ◽

Wilco P Achterberg ◽

François G Schellevis ◽

...

Keyword(s):

Long Term Care ◽

Antibiotic Prescribing ◽

Term Care ◽

Factors Influencing ◽

Care Facilities ◽

Depth Study

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An Integrated Review of Evidence-based Healthcare Designfor Healing Environments: Focusing on Long-term Care Facilities

Journal of Integrated Design Research ◽

10.21195/jidr.2014.13.2.013 ◽

2014 ◽

Vol 13 (2) ◽

pp. 147-162

Author(s):

Jinkyung Paik ◽

안지영 ◽

Suk-Tae Kim ◽

성윤정 ◽

Younggyu Cho

Keyword(s):

Long Term Care ◽

Evidence Based ◽

Term Care ◽

Care Facilities ◽

Healing Environments ◽

Evidence Based Healthcare

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2055. Action: A Year in the Lives of Consultant Pharmacists Working on Antimicrobial Stewardship in Long-Term Care Facilities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1735 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S692-S693

Author(s):

Philip Chung ◽

Alex Neukirch ◽

Rebecca J Ortmeier ◽

Scott Bergman ◽

Mark E Rupp ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

First Generation ◽

Long Term Care ◽

Diagnostic Testing ◽

Drug Regimen ◽

Term Care ◽

Clostridioides Difficile ◽

Care Facilities ◽

Tract Infections

Abstract Background The CDC recommends consultant pharmacists (CP) support antimicrobial stewardship (AS) activities in long-term care facilities (LTCF) by reviewing antimicrobial appropriateness. We initiated a project training CP from a regional long-term care pharmacy to support AS implementation in LTCF. Methods CP were trained to evaluate the appropriateness of all systemic antimicrobial therapy (AT) and provide prescriber feedback during their monthly drug regimen review (DRR). An electronic database was developed to facilitate data reporting. Antimicrobial use (AU) and adverse events (AE) from 32 LTCF were analyzed for 2018 using descriptive statistics. Results A total of 5327 courses of AT with a median duration of 7 days (IQR 5–10) were reviewed. The majority of AT was started in the LTCF (55%) but was also initiated in hospitals (24%), clinics (11%) and emergency departments (2%). Of 2926 AT started in LTCF, 36% were based on nurse evaluation (NE) while 33% began after prescriber evaluation (PE). Fluoroquinolones (FQ) and first-generation cephalosporins were the most commonly prescribed agents (Table 1). Treatment or prophylaxis of urinary tract infections accounted for 40% of AU (Figure 1). Diagnostic testing was associated with 37% of AT courses. Urine cultures were the most frequent test performed (81%). Overall, 41% of AT was determined to be inappropriate resulting in > 800 feedback letters sent to prescribers. Unnecessary antibiotic starts (based on revised Mc Geer or Loeb’s criteria) were identified as the most common reason (Figure 2). AT appropriateness varied depending on the setting in which it was initiated. A majority (87%) of AT initiated in hospitals was found to be appropriate with 56% and 46% appropriate for ED and clinic starts. Appropriateness of LTCF initiated AT was 49% (59% after PE and 42% after NE). AE were associated with 3% of AT with allergic reactions and Clostridioides difficile infections occurring with 0.4% and 0.7% of AT, respectively. AE were most frequently associated with folate antagonists (5%) and FQ (3%). Conclusion This study demonstrates many AU improvement opportunities exist in LTCF and CP can play an important role in identifying them if trained in AS principles. CP should review all AU for appropriateness and provide data to inform AS efforts in LTCF. Disclosures All authors: No reported disclosures.

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