Abstract
AbstractWe compared antibiotic prescribing to older people in different settings to inform antibiotic stewardship interventions. We used data linkage to stratify individuals aged 65 years and over in Northern Ireland, 1st January 2012–31st December 2013, by residence: community dwelling, care home dwelling or ‘transitioned’ if admitted to a care home. The odds of being prescribed an antibiotic by residence were analysed using logistic regression, adjusting for patient demographics and selected medication use (proxy for co-morbidities). Trends in monthly antibiotic prescribing were examined in the 6 months pre- and post-admission to the care home. The odds of being prescribed at least one antibiotic were twofold higher in care homes compared with community dwellers (adjusted odds ratio 2.05, 95% CI 1.93–2.17). There was a proportionate increase of 51.5% in the percentage prescribed an antibiotic on admission, with a monthly average of 23% receiving an antibiotic in the 6 months post admission. While clinical need likely accounts for some of the observed antibiotic prescribing in care homes we cannot rule out more liberal prescribing, given the twofold difference between care home residents and their community dwelling peers having accounted for co-morbidities. The appropriateness of antibiotic prescribing in the care home setting should be examined.
Highlights
Recent estimates indicate that if trends in antimicrobial resistance (AMR) continue unabated, by 2050, 10 million lives will be lost each year to AMR at a cumulative cost to global economic output of $100 trillion US dollars [1]
Antibiotic prescribing for older people in care homes has been recognised as a global problem which raises the concern about how this may drive resistance and facilitate spread through inter-person transmission [10]
The largest change in antibiotic use was observed in those who transitioned into care, with an absolute difference between January 2012 and January 2013 of 11.8%, and a relative change of 2.4
Summary
Recent estimates indicate that if trends in antimicrobial resistance (AMR) continue unabated, by 2050, 10 million lives will be lost each year to AMR at a cumulative cost to global economic output of $100 trillion US dollars [1]. Rates of antibiotic prescribing are highest at the extremes of age [6,7,8]. While interventions such as efforts to reduce inappropriate prescribing and national vaccination campaigns have helped to improve prescribing rates in the younger age groups antibiotic prescribing for the older population appears to be increasing [9]. Antibiotic prescribing for older people in care homes has been recognised as a global problem which raises the concern about how this may drive resistance and facilitate spread through inter-person transmission [10]. Obtaining estimates of the burden of AMR in the care home setting is challenging due to a lack of routine surveillance in this setting but a recent population based study comparing residents of long-term care facilities to their community dwelling peers showed higher levels of AMR in the care home setting [11]
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