Abstract
BackgroundLong-term care facilities (LTCFs) are important locations of antimicrobial consumption. Of particular concern is inappropriate prescribing of prophylactic antimicrobials. AimWe aimed to explore factors related to antimicrobial prophylaxis in LTCFs in Ireland. MethodsThe point prevalence surveys of Healthcare-Associated Infections in Long-Term Care Facilities (HALT) were performed in Ireland in May 2013 and 2016. Data were collected on facility (type and stewardship initiatives) and resident characteristics (age, sex, antimicrobial and indication) for those meeting the surveillance definition for a HAI and/or prescribed an antimicrobial. ResultsIn 2013, 9,318 residents (in 190 LTCFs) and in 2016, 10,044 residents (in 224 LTCFs) were included. Of the 10% of residents prescribed antimicrobials, 40% were on prophylaxis, most of which was to prevent urinary tract infection. The main prophylactic agents were: nitrofurantoin (39%) and trimethoprim (41%) for urinary tract (UT); macrolides (47%) for respiratory tract and macrolides and tetracycline (56%) for skin or wounds. More than 50% of the prophylaxis was prescribed in intellectual disability facilities and around 40% in nursing homes. Prophylaxis was recorded more often for females, residents living in LTCFs for more than 1 year and residents with a urinary catheter. No difference in prophylactic prescribing was observed when comparing LTCFs participating and not participating in both years. ConclusionsForty per cent of antimicrobial prescriptions in Irish LTCFs were prophylactic. This practice is not consistent with national antimicrobial prescribing guidelines. Addressing inappropriate prophylaxis prescribing in Irish LTCFs should be a key objective of antimicrobial stewardship initiatives.
Highlights
Antimicrobial resistance (AMR) is a major global concern
Overall antimicrobial prescribing was higher among general nursing homes (GNHs) residents compared with any other Long-term care facilities (LTCFs) types in both Healthcare-Associated Infections in Long-Term Care Facilities (HALT) surveys, while the proportion of residents receiving prophylaxis was higher among residents in intellectual disability
A higher proportion of prophylactic antimicrobial prescribing was observed in relation to the respiratory tract in 2016 compared with 2013 in Irish LTCFs
Summary
Antimicrobial resistance (AMR) is a major global concern. The overuse and misuse of antimicrobials in both humans and animals are the leading drivers of AMR [1]. The second EU/EEA point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in long-term care facilities (LTCFs), performed in 2013, reported a crude European prevalence of residents on antimicrobials in LTCFs of 4%, ranging from 1% in Hungary to 12% in Greece [2]. Methods: The point prevalence surveys of Healthcare-Associated Infections in Long-Term Care Facilities (HALT) were performed in Ireland in May 2013 and 2016. Of the 10% of residents prescribed antimicrobials, 40% were on prophylaxis, most of which was to prevent urinary tract infection. Conclusions: Forty per cent of antimicrobial prescriptions in Irish LTCFs were prophylactic This practice is not consistent with national antimicrobial prescribing guidelines. Addressing inappropriate prophylaxis prescribing in Irish LTCFs should be a key objective of antimicrobial stewardship initiatives
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More From: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
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