Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

Wu, Lisa Dong-Ying; Walker, Sandra A N; Elligsen, Marion; Palmay, Lesley; Simor, Andrew E.; Daneman, Nick

doi:10.4212/cjhp.v68i6.1500

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…While C. difficile was the most commonly diagnosed gastrointestinal infection, it accounted for less than 2% of HAIs. Similar rates of C. difficile infection have been described in adult LTC populations [12, 16]. However, treatment of recurrent C. difficile infection with an oral vancomycin taper accounted for the longest antibiotic duration (60 days) in these paediatric LTC facilities.…”

Section: Discussionsupporting

confidence: 61%

“…This finding reflects age-related differences in risk for these types of infections. The types of antibiotic agents used in this study were also similar to those seen in adult LTC where use of fluoroquinolones and cephalosporins are common [5, 11, 12]. Additionally, we did note some unique patterns of antibiotic use, such as inhaled tobramycin for 9% of treated acute respiratory tract infections.…”

Section: Discussionsupporting

confidence: 60%

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Use of antibiotics in paediatric long-term care facilities

Murray

Johnson

Cohen

et al. 2018

Journal of Hospital Infection

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STRUCTURED SUMMARY Background Adult long term care (LTC) have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC. Aim We sought to describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. Methods A retrospective cohort study was conducted September 2012 – December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAI), antimicrobial use, and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi square. Findings Fifty-eight percent (413/717) of residents had at least one HAI, 79% (325/413) of whom were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurologic disorder, having a tracheostomy, and being hospitalised at least once during the study were significantly associated with receiving antibiotics when controlling for facility (all p <0.001). Diagnostic testing was performed for 40% of antibiotic-treated HAI. Eighty-six percent of antibiotic courses for identified bacterial pathogens (n=201/233) provided appropriate coverage. Having access to susceptibility testing was not associated with appropriate antibiotic choice. (p=0.26). Conclusion Use of antibiotics in paediatric LTC facilities is widespread. There is further need to assess antibiotic use in paediatric LTC. Evaluation of the adverse outcomes associated with inappropriate antibiotic use including the prevalence of resistant organisms in paediatric LTC facilities is critical.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 60%

Use of antibiotics in paediatric long-term care facilities

Murray

Johnson

Cohen

et al. 2018

Journal of Hospital Infection

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“…The mean age of residents on antimicrobial treatment in our study was 83.4 years, which is only slightly higher than the mean age in the HALT (82.5 years) and in HALT-2 (81.8 years) studies and comparable to the two ESAC reports (83 years). The population in the Norwegian study was older than in Slovenian LTCFs (76% vs 66.8% of residents aged 80 years or older) and some of the residents lived in facilities which specialised in dementia care [ 17 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial prescribing in long-term care facilities: a nationwide point-prevalence study, Slovenia, 2016

et al. 2018

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Residents in long-term care are at high risk of infections because of their old age and many related health problems that lead to frequent antibiotic prescribing. The aim of the study was to assess antibiotic use in Slovenian long-term care facilities (LTCFs). The point-prevalence study was conducted between April and June 2016. Online questionnaires were sent to all Slovenian LTCFs. Eighty (68.4%) of the 117 LTCFs contacted, caring for 13,032 residents (70.6% of all Slovenian LTCF residents), responded to the survey. On the day of the study, the mean antibiotic prevalence per LTCF was 2.4% (95% confidence interval: 1.94–2.66). Most (70.2%) of the residents taking antibiotics were female. Most residents were being treated for respiratory tract (42.7%) or urinary tract (33.3%) infections. Co-amoxiclav and fluoroquinolones were the most frequently prescribed antibiotics (41.0% and 22.3% respectively). Microbiological tests were performed for 5.2% of residents receiving antibiotics. Forty nine (19.8%) residents receiving antibiotics were colonised with multidrug-resistant bacteria (MDR). Antibiotic use in Slovenian LTCFs is not very high, but most prescribed antibiotics are broad-spectrum. Together with low use of microbiological testing and high prevalence of colonisation with MDR bacteria the situation is worrisome and warrants the introduction of antimicrobial stewardship interventions.

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“…The increasing incidence of antibiotic resistance has been described as a global public health threat, and concerted efforts are required to address the problem. In this issue of the CJHP, Wu and others 1 describe a small audit of antibiotic use in a long-term care facility. The audit identified overdependence on third-generation cephalosporins and fluoroquinolones, together with presumptive diagnoses in the absence of sensitivity testing.…”

mentioning

confidence: 99%

“…The systematic review by Kaki and others 12 (referenced by Wu and others 1 ) is limited in its generalizability, as it included only papers conducted in critical care. However, it did show that antibiotic stewardship could lead to reductions in antibiotic utilization and costs, shorter duration of treatment, more appropriate use of these drugs, fewer adverse events, and less long-term use.…”

mentioning

confidence: 99%