Abstract
BackgroundOlder people living in care homes are particularly susceptible to infections and antibiotics are therefore used frequently for this population. However, there is limited information on antibiotic prescribing in this setting. This study aimed to investigate the frequency, patterns and risk factors for antibiotic prescribing in a large chain of UK care homes.MethodsRetrospective cohort study of administrative data from a large chain of UK care homes (resident and care home-level) linked to individual-level pharmacy data. Residents aged 65 years or older between 1 January 2016 and 31 December 2017 were included. Antibiotics were classified by type and as new or repeated prescriptions. Rates of antibiotic prescribing were calculated and modelled using multilevel negative binomial regression.Results13,487 residents of 135 homes were included. The median age was 85; 63% residents were female. 28,689 antibiotic prescriptions were dispensed, the majority were penicillins (11,327, 39%), sulfonamides and trimethoprim (5818, 20%), or other antibacterials (4665, 16%). 8433 (30%) were repeat prescriptions. The crude rate of antibiotic prescriptions was 2.68 per resident year (95% confidence interval (CI) 2.64–2.71). Increased antibiotic prescribing was associated with residents requiring more medical assistance (adjusted incidence rate ratio for nursing opposed to residential care 1.21, 95% CI 1.13–1.30). Prescribing rates varied widely by care home but there were no significant associations with the care home-level characteristics available in routine data.ConclusionsRates of antibiotic prescribing in care homes are high and there is substantial variation between homes. Further research is needed to understand the drivers of this variation to enable development of effective stewardship approaches that target the influences of prescribing.
Highlights
Older people living in care homes are susceptible to infections and antibiotics are used frequently for this population
Frequent antibiotic use can be problematic for this population because they are at increased risk of adverse events related to antibiotic treatment such as infection with Clostridium difficile, side effects, and drug-drug interactions [9]
Increased numbers of reported infections and higher levels of co-morbidity were associated with increased antibiotic prescribing
Summary
Older people living in care homes are susceptible to infections and antibiotics are used frequently for this population. Around one in seven people aged over 85 live in approximately 20,000 care homes in the United Kingdom [1,2,3,4,5] This includes residential homes, which provide accommodation and personal care, and nursing homes, in which at least one qualified nurse is always on duty [6]. Residents admitted to hospital frequently return to care homes and go back to hospital, creating the opportunity for transmission of infections, including drug-resistant pathogens, between healthcare settings [11]. Avoiding these adverse events requires identification of opportunities to safely reduce antibiotic use (antibiotic stewardship). To do this, detailed information on how antibiotics are currently used in this setting is needed
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