Antibiotic prescribing in care homes in the UK, 2016–17: a cross-sectional study of linked data

Abstract

BackgroundOlder people living in care homes are particularly susceptible to infections and are at high risk of adverse outcomes related to antibiotic treatment. However, information on antibiotic prescribing in this setting is scarce. We aimed to describe the frequency of antibiotic prescribing for different infections for residents of UK care homes. MethodsThis was a cross-sectional study of residents of a chain of 135 UK care homes (93 in England, 20 in Northern Ireland, 19 in Scotland, three in Wales) between Jan 1, 2016, and Dec 31, 2017. Residents were excluded if they were younger than 65 years (n=657) or had a length of stay of 0 days (n=50). We extracted information on demographics (age, sex, length of stay) and infections (type, date) from care home systems. Infections were reported by care home staff using an internal incident management system. We extracted antibiotic prescriptions from the system of a large national pharmacy chain (contracted to fulfil prescriptions to the care home chain) and linked them to the resident-level data. We analysed resident characteristics using descriptive statistics and calculated the crude rate of antibiotic prescribing. We identified antibiotics prescribed within 2 days of reported infections and estimated proportions of antibiotic prescription for different infections. This study was approved by the UCL Research Ethics Committee (ID 11813/002). Findings13 487 residents stayed in the homes for a total of 3 916 931 days during the 2-year study period and were included in the analysis. The median number of beds per care home was 50 (range 25–111). Median age of residents was 85 years (IQR 79–90), and 8518 (63%) residents were women. 28 689 antibiotics were prescribed, a crude rate of 2·7 per resident-year. Overall, 5237 (52%) of 9986 of reported infections led to an antibiotic prescription, with similar proportions across common infection types: chest (2435 [55%] 4420), urinary tract (2332 [55%] 4232), and cellulitis (308 [57%] of 538). InterpretationThe rate of antibiotic prescribing is much higher for care home residents than for the general population, particularly for chest infections, many of which might be viral. This is an important area for further research and development of stewardship interventions. Strengths of the study were its large scale and use of novel data linkages. Limitations included absence of information on temporary absences from homes. Further work will estimate effects of resident and care home factors on antibiotic prescribing. FundingEconomic and Social Research Council (grant number ES/P008321/1), as part of the Preserving Antibiotics through Safe Stewardship (PASS) project.