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4CPS-040 Adequacy of antibiotic prescriptions in a nursing home
  1. MR Cantudo Cuenca1,
  2. BM Muñoz Cejudo1,
  3. L Dani Ben Abdel-Lah1,
  4. MA Mora Mora1,
  5. JE Martínez De La Plata2
  1. 1Hospital San Agustín Área De Gestión Sanitaria Norte De Jaén, Pharmacy, Linares, Spain
  2. 2Agencia Pública Empresarial Sanitaria Hospital De Poniente, Pharmacy, El Ejido, Spain


Background and importance The pervasive use of antibiotics has been identified as a major public health threat due to the emergence of antibiotic resistant bacteria. Antibiotics are among the most commonly prescribed drugs in nursing homes (NHs) and up to 75% of these are considered inappropriate.

Aim and objectives To characterise antibiotic therapy in NHs and evaluate adequacy.

Material and methods A prospective study was conducted in a NHs (264 residents) over a 3 month period (July–September 2019). All residents with antibiotic prescriptions for suspected infections were included. Data were collected by review of medical and pharmacy records: demographic and clinical characteristics, risk factors for infection, antibiotic prescribed, indication and microbiology data.

Inadequate antibiotic therapy was defined as: (1) conditions without an antibiotic indication; (2) non-adherence to therapeutic guidelines; (3) incorrect dose, route of administration or duration; (4) no microbiology sample collection when needed; and (5) microbiological evidence of infection not covered by the chosen antibiotics, or no antibiotic de-escalation.

Results We included 62 residents, mean age 81.7±10.7 years, 69.4% women, and 6.5% had an antibiotic allergy. Mean Charlson comorbidity index age adjusted was 5.8±1.9. The majority of residents presented risk factors for infection (RFF) (95.2%), mean 3.1±1.4. RFF included functional dependency (6.9% of patients), previous antibiotic therapy (59.7%) and cognitive impairment (53.2%).

The most commonly prescribed antibiotics were amoxicillin/clavulanic (24.2%), quinolones (19.4%), fosfomycin–trometamol (19.4%), cephalosporins (11.2%), fosmomycin calcium (9.7%), cloxacillin (9.7%) and other (6.4%). Mean duration was 5.6±3.5 days. Most treatments were empirical (75.8%), 21% were targeted treatment and 3.2% were prophylactic. Combination therapy was found in only one case; three intravenous route.

The most common infection was urinary tract infection (48.4%), followed by skin and soft tissue infection (22.6%) and lower respiratory tract infection (21%). Sample collection was carried out in 41.9% (76.9% before initiating antibiotic): 65.4% uroculture, 11.5% exudate culture and 23.1% others. Most of the cultures were positive (80.8%; 71.4% were monomicrobial infections). The most prevalent microorganisms isolated were gram negative isolates (85.7%); methicillin resistant Staphylococcus aureus was isolated in three cases (14.3%).

Antibiotic therapy was inadequate in 51.6%: (1) 9.3%; (2) 56.3%; (3) 12.5%; (4) 3.2%; and (5) 18.7%.

Conclusion and relevance Broad spectrum antibiotics are often prescribed. There was a high number of inadequate antibiotic prescriptions. Pharmacy teams are well placed to support prudent selection of antibiotic therapy in NHs.

References and/or acknowledgements No conflict of interest.

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