How does antibiotic use in Australian residential aged care compare globally?: A systematic review and meta-analysis

Abstract

Introduction: Inappropriate antibiotic use in residential aged care (RAC) is a concern globally. The World Health Organization recommends surveillance of antibiotic use as part of its strategy to curb antimicrobial resistance. A number of recent programs have been initiated to monitor antibiotic use in RAC; however, a global comparison of estimates from these is not available. We aimed to analyse the international literature to summarise antibiotic use in RAC by region, including for Australia.Methods: We conducted a systematic review, meta-analysis and meta-regression of key indicators of antibiotic use in RAC. Random effects meta-analyses with subgroups by region were conducted. Meta-regression compared use in regions (providing odds ratios [OR]), while adjusting for year of data.Results: Ninety articles reporting antibiotic use across 38 countries were included. Meta-analyses and meta-regression were conducted for point prevalence (n=123 estimates) and 12-month period prevalence (n=19 estimates) of antibiotic use. Data reported for other measures of antibiotic use (e.g. days of therapy/1000 resident days; defined daily doses/1000 resident days) precluded meta-analysis and were summarised narratively. People living in RAC in Australia had higher odds of using an antibiotic on a single day and over 12-months compared to other regions (e.g. Eastern Europe, Western Europe, Asia and the British Isles). Point estimates and odds ratios with 95% confidence intervals will be presented.Conclusion: Antibiotic use in RAC in Australia is higher compared to some regions. There is a need for targeted antimicrobial stewardship programs in RAC to reduce unnecessary antibiotic use in this population. Introduction: Inappropriate antibiotic use in residential aged care (RAC) is a concern globally. The World Health Organization recommends surveillance of antibiotic use as part of its strategy to curb antimicrobial resistance. A number of recent programs have been initiated to monitor antibiotic use in RAC; however, a global comparison of estimates from these is not available. We aimed to analyse the international literature to summarise antibiotic use in RAC by region, including for Australia. Methods: We conducted a systematic review, meta-analysis and meta-regression of key indicators of antibiotic use in RAC. Random effects meta-analyses with subgroups by region were conducted. Meta-regression compared use in regions (providing odds ratios [OR]), while adjusting for year of data. Results: Ninety articles reporting antibiotic use across 38 countries were included. Meta-analyses and meta-regression were conducted for point prevalence (n=123 estimates) and 12-month period prevalence (n=19 estimates) of antibiotic use. Data reported for other measures of antibiotic use (e.g. days of therapy/1000 resident days; defined daily doses/1000 resident days) precluded meta-analysis and were summarised narratively. People living in RAC in Australia had higher odds of using an antibiotic on a single day and over 12-months compared to other regions (e.g. Eastern Europe, Western Europe, Asia and the British Isles). Point estimates and odds ratios with 95% confidence intervals will be presented. Conclusion: Antibiotic use in RAC in Australia is higher compared to some regions. There is a need for targeted antimicrobial stewardship programs in RAC to reduce unnecessary antibiotic use in this population.