Antibiotic stewardship in French nursing homes: a 2019 regional survey

Abstract

Background Antibiotic resistance is a growing issue in nursing homes (NHs). Antibiotic stewardship (ABS) programmes can reduce antibiotic use in NHs, but few studies have assessed to what extent they are implemented in NHs. Objectives To describe ABS current practices and describe the opinion of NH stakeholders regarding ABS and opportunities for improvement in one French region. Methods We invited by e-mail the medical and nurse coordinators of all NHs of the Grand Est region, France, to participate in our survey in 2019. The online questionnaire included 35 questions covering four topics: NH characteristics, current ABS practices, attitudes towards ABS and opinions on strategies to promote ABS. A score evaluating implementation of core ABS elements was calculated using the current ABS practice responses. Results Out of 417 NHs, 75 (18%) participated in our survey. The three most implemented ABS activities were antibiotic consumption monitoring (65%), antibiotic plan documentation (56%) and antibiotic prescription guide distribution (54%). Audit and feedback, training sessions or identification of a local ABS leader ranged from 13% to 29%. Participants positively perceived ABS and most suggestions to improve ABS programmes in NH, with maximal interest in training, audit and feedback interventions. The median score for implementation of core ABS elements was 3.3 (IQR = 2.3–5.4; theoretical range 0–11), and the score distribution was not associated with any NH characteristic. Conclusions While there is still room for improvement, NHs had a positive attitude towards ABS strategies. Some regional and national initiatives to promote ABS in NHs exist and should be actively promoted.

Nurses’ perceptions of the potential evolution of their role in antibiotic stewardship in nursing homes: a French qualitative study

“…evaluate the appropriateness of the empirical antibiotic therapy and monitor antibiotic consumption) commonly implemented in our region according to Belan et al . 12 APRNs believe they can prescribe first-line antibiotics for UTIs. We can notice that NHNs/APRNs only thought about patient-centred missions but not about more collective missions such as the promotion of ABS programmes, although they might have a role to play.…”

“…French evidence-based guidelines dedicated to ABS in NHs can improve this situation, 12 as well as the French ‘2022–2025 National Strategy for Preventing Infections and Antibiotic Resistance’, which mentions the implementation of core ABS elements in NHs. 11 Regional health authorities and regional ABS networks could implement these elements.…”

“…11 Regional health authorities and regional ABS networks could implement these elements. 12 Potential forms of evolution could be achieved by the involvement of NH administrators, who should enhance and promote ABS practices 22 and organize them, taking into account the NHN’s central role in routine patient care. 45 …”

“… 50 However, this requires that NHNs are made aware of existing national or regional ABS initiatives, infection training and tools. 12 …”