Background and importance Antimicrobials are the most frequently prescribed drugs in long-term care facilities (LTCF). Antibiotic prescriptions may be unnecessary; but even when necessary, the antibiotics prescribed are often excessively broad-spectrum or longer duration.
Aim and objectives To evaluate appropriateness of antibiotic prescriptions in a LTCF and analyse possible factors related to inappropriateness.
Material and methods An 18-month prospective study was conducted in a 264-bed LTCF. Antibiotic prescriptions for suspected lower respiratory tract infection (LRTI), skin and soft tissue infection (SSTI) or urinary tract infection (UTI) initiated for LTCF residents were included. We excluded confirmed positive COVID-19 infections without suspected bacterial/fungal co-infection and prophylactic antibiotic prescriptions. We obtained demographic and clinical characteristics of residents, variables related to infection and antibiotic prescription, microbiology data and setting of prescription initiation. Each antibiotic prescription was assessed for appropriateness and classified as unnecessary, inappropriate and suboptimal antimicrobial use.1 Associations of variables with inappropriate antibiotic prescribing were estimated using logistic regression.
Results We included 416 antibiotic prescriptions (out of 489) corresponding to 159 residents, 43.6% women, mean age 83.2 (SD 9.6) years. Fosfomycin-tromethamine was the most commonly prescribed antibiotic (25.0%), followed by cephalosporins (18.8%), amoxicillin-clavulanic acid (15.9%) and fluoroquinolones (13.0%). Polytherapy: 2.6 % of episodes.Infections: UTI (43.3%), LRTI (34.6%), SSTI (22.1%). Targeted therapy: 16.8%. Median treatment duration: 5 (IQR 1–7) days; 9.4% prescriptions for >7 days. Sample collection was carried out in 29.6%. Positive result: 82.9% of cultures. The most prevalent microorganisms isolated were the Gram-negative bacteria (87.3%). The majority of antibiotic prescriptions were initiated within the LTCF (84.1%), with 12.7% by the emergency department (ED) and 3.2% by hospital or primary care (HPC). Overall, 46.6% of antibiotic prescriptions were judged unsuitable: unnecessary (16.9%), inappropriate (70.6%), suboptimal (12.5%). Multivariable analysis showed that empirical therapy, some classes of antibiotics (cephalosporins, fluoroquinolones, fosfomycin calcium, macrolides) and prescription initiation in the emergency department were independent predictors of antimicrobial inappropriateness.
Conclusion and relevance Almost half of antimicrobials prescriptions are inappropriate. Antibiotics initiated in the ED constitutes a small but not unimportant percentage of all prescriptions. Antimicrobial stewardship programmes should include interventions in this setting because of the high inappropriate use.
References and/or acknowledgements 1. Spivak ES, et al. Measuring appropriate antimicrobial use: attempts at opening the black box. Clin Infect Dis 2016;63(12):1639–1644.
Conflict of interest No conflict of interest
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