Quantity Metrics and Proxy Indicators to Estimate the Volume and Appropriateness of Antibiotics Prescribed in French Nursing Homes: A Cross-sectional Observational Study Based on 2018 Reimbursement Data

Abstract

Background Antibiotic resistance is an increasing threat to public health globally. Indicators on antibiotic prescribing are required to guide antibiotic stewardship interventions in nursing homes. However, such indicators are not available in the literature. Our main objective was to provide a set of quantity metrics and proxy indicators to estimate the volume and appropriateness of antibiotic use in nursing homes. Methods Recently published articles were first used to select quantity metrics and proxy indicators, that were adapted to the French nursing home context. A cross-sectional observational study was then conducted based on reimbursement databases. We included all community-based nursing homes of the Lorraine region in north-eastern France. We presented descriptive statistics for quantity metrics and proxy indicators. For proxy indicators, we also assessed performance scores, clinimetric properties (measurability, applicability, and room for improvement), and conducted case-mix and cluster analyses. Results 209 nursing homes were included. We selected fifteen quantity metrics and eleven proxy indicators of antibiotic use. The volume of antibiotic use varied hugely between nursing homes. Proxy indicators’ performance scores were low, and variability between nursing homes was high for all indicators, highlighting an important room for improvement. Six out of the eleven proxy indicators had good clinimetric properties. Three distinct clusters were identified according to the number of proxy indicators for which the acceptable target was reached. Conclusion This set of fifteen quantity metrics and eleven proxy indicators may be adapted to other contexts and could be used to guide antibiotic stewardship programmes in nursing homes.

Surveillance: a prerequisite for effective antimicrobial stewardship

“…These indicators share characteristics of both quantity metrics and quality indicators and can indirectly reflect the appropriateness of antibiotic use if associated with a clear target [17]. Examples are a seasonal variation of quinolone prescriptions for general practitioners [17] and the percentage of antibiotic prescriptions with a duration of >8 days in nursing homes [18]. The advantage of proxy indicators is that they are derived from data that can be easily extracted from electronic systems compared to measuring quality indicators, which requires a large time investment, while proxy indicators provide a clearer direction to improve performance in daily practice (i.e.…”

Nursing home nurses' opinions on the potential evolution of their role in antibiotic stewardship: A French national cross‐sectional survey

“…Pooling data from 78 studies from 39 countries, Raban et al estimated the prevalence of antibiotic use in nursing homes at 5.2% over 1 day (95% CI: 3.3-7.9) and 62.0% over 1 year (54.0-69.3); the estimated proportion of appropriate antibiotic prescriptions, which assessed whether an antibiotic treatment was warranted based on the presence of infectious symptoms (McGeer criteria), was 28.5% (10.3-58.0) (Raban et al, 2021). In France, where antibiotic use is one of the highest in Europe (European centre for disease prevention and control, 2020), most antibiotics are prescribed in the community or in nursing homes (Bridey et al, 2023), and there is considerable room for improvement in nursing homes (Simon et al, 2021). Consequently, older people in nursing homes have a higher risk of infection with antibioticresistant bacteria than their community-dwelling peers, estimated to be, for example, 40% higher for Enterobacteriaceae cultured from urine samples (Pulcini et al, 2019).…”

Antimicrobial resistance in long-term care facilities

“…system for proper surveillance and feedback that includes monitoring of antimicrobial consumption and AMR can help identify and quantify the problem, and is an essential component of any ASP Health information on optimal use of antimicrobials should be shared with LTCFs residents, their relatives and visitors on a regular basis to ensure optimal collaboration Surveillance data are needed in LTCFs and can help assess the effectiveness of ASP interventions, for benchmarking and observation of trends and to develop institution specific guidelines to estimate the volume and appropriateness of antibiotics in LTCFs would be welcome, as illustrated by Simon and colleagues(Simon et al, 2020…”