Antibiotic use in the care home setting: a retrospective cohort study analysing routine data

BMC Geriatrics

Michael Moore¹  Paul Roderick¹  Martin Davis¹  Beth Stuart¹  Pär-Daniel Sundvall² 

[1] Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Mailpoint 805, C floor, South Academic Block, Southampton General Hospital, Southampton SO166YD, UK;Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden

关键词: Family practice;    Bacteriuria;    Urinary tract infections;    Homes for the aged;    Nursing homes;    Anti-bacterial agents;   

Others  :  1218278
DOI  :  10.1186/s12877-015-0073-5

 received in 2015-01-13, accepted in 2015-06-15,  发布年份 2015

【 摘 要 】

Background

Point prevalence studies in care homes show a high use of antibiotics, especially to treat urinary tract infections (UTI). There is a lack of large studies presenting annual antibiotic prescription data in care homes compared to those not in care homes. This study aimed to describe the pattern of antibiotic prescribing in those 75 years and over, with a focus on UTI.

Methods

In this retrospective longitudinal cohort study we used the Hampshire Health Record (HHR) containing routine data from general practices in Hampshire area, UK covering 1.24 million residents. Data were extracted throughout 2011 from the Hampshire Health Record on age, gender, care home status, antibiotic prescriptions, urinary catheters and comorbidity. Prescription pattern expressed as rate per 100 people. Nursing home residence defined by postcode. Logistic regression was used to assess independent risk of one or more antibiotic prescriptions in care home residents adjusting for age, sex and comorbidity, separately by catheter use.

Results

102,020 of 1,244,313 residents in the Hampshire Health Record (8.2 %) were aged ≥75 years of whom 7481 (7.3 %) were resident in care home settings. The annual antibiotic prescriptions increased from 53/100 inhabitants among those <75 years, to 142/100 among those ≥75 years not in a care home and to 199/100 among those ≥75 years in a care home. Care home residents with urinary catheters (4.4 %) had even higher use at 440/100 versus 188/100 if no catheter. UTI antibiotics showed a similar but more rapidly increasing pattern. For those in care homes without a urinary catheter, the odds ratio was 2.2 (2.1–2.3) higher for prescriptions of UTI antibiotics compared to those not in care homes after adjusting for age, gender and comorbidity. For those with a urinary catheter the odds ratio was 1.4 (1.1–1.8) for UTI antibiotics compared to those not in care homes. For all antibiotics the odds ratio was 1.2 (1.2–1.3).

Conclusions

Residence in a care home setting is associated with high antibiotic consumption; this is especially evident for UTI antibiotics where the odds of prescription is doubled.

【 授权许可】

   
2015 Sundvall et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]WHO: The evolving threat of antimicrobial resistance - options for action. World Health Organization, Geneva; 2012.
• [2]Cohen AE, Lautenbach E, Morales KH, Linkin DR: Fluoroquinolone-resistant Escherichia coli in the long-term care setting. Am J Med 2006, 119(11):958-63.
• [3]Cohen-Nahum K, Saidel-Odes L, Riesenberg K, Schlaeffer F, Borer A: Urinary tract infections caused by multi-drug resistant Proteus mirabilis: risk factors and clinical outcomes. Infection 2010, 38(1):41-6.
• [4]Vellinga A, Murphy AW, Hanahoe B, Bennett K, Cormican M: A multilevel analysis of trimethoprim and ciprofloxacin prescribing and resistance of uropathogenic Escherichia coli in general practice. J Antimicrob Chemother 2010, 65(7):1514-20.
• [5]Strausbaugh LJ, Crossley KB, Nurse BA, Thrupp LD: Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996, 17(2):129-40.
• [6]Walker S, McGeer A, Simor AE, Armstrong-Evans M, Loeb M: Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? A qualitative study of physicians’ and nurses’ perceptions. CMAJ 2000, 163(3):273-7.
• [7]Juthani-Mehta M, Drickamer MA, Towle V, Zhang Y, Tinetti ME, Quagliarello VJ: Nursing home practitioner survey of diagnostic criteria for urinary tract infections. J Am Geriatr Soc 2005, 53(11):1986-90.
• [8]Sundvall PD, Ulleryd P, Gunnarsson RK: Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes. BMC Fam Pract 2011, 12:36. BioMed Central Full Text
• [9]Nace DA, Drinka PJ, Crnich CJ: Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc 2014, 15(2):133-9.
• [10]Sundvall PD, Elm M, Ulleryd P, Molstad S, Rodhe N, Jonsson L, Andersson B, Hahn-Zoric M, Gunnarsson R: Interleukin-6 concentrations in the urine and dipstick analyses were related to bacteriuria but not symptoms in the elderly: a cross sectional study of 421 nursing home residents. BMC Geriatr 2014, 14:88. BioMed Central Full Text
• [11]Nicolle LE: Urinary tract infection in long-term-care facility residents. Clin Infect Dis 2000, 31(3):757-61.
• [12]D’Agata E, Loeb MB, Mitchell SL: Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. J Am Geriatr Soc 2013, 61(1):62-6.
• [13]Phillips CD, Adepoju O, Stone N, Moudouni DK, Nwaiwu O, Zhao H, Frentzel E, Mehr D, Garfinkel S: Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes. BMC Geriatr 2012, 12:73. BioMed Central Full Text
• [14]Schweizer AK, Hughes CM, Macauley DC, O’Neill C: Managing urinary tract infections in nursing homes: a qualitative assessment. Pharm World Sci 2005, 27(3):159-65.
• [15]Sun L, Klein EY, Laxminarayan R: Seasonality and temporal correlation between community antibiotic use and resistance in the United States. Clin Infect Dis 2012, 55(5):687-94.
• [16]Little P, Merriman R, Turner S, Rumsby K, Warner G, Lowes JA, Smith H, Hawke C, Leydon G, Mullee M, et al.: Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ 2010, 340:b5633.
• [17]McClean P, Hughes C, Tunney M, Goossens H, Jans B: Antimicrobial prescribing in European nursing homes. J Antimicrob Chemother 2011, 66(7):1609-16.
• [18]Haasum Y, Fastbom J, Johnell K: Different patterns in use of antibiotics for lower urinary tract infection in institutionalized and home-dwelling elderly: a register-based study. Eur J Clin Pharmacol 2013, 69(3):665-71.
• [19]Latour K, Catry B, Broex E, Vankerckhoven V, Muller A, Stroobants R, Goossens H, Jans B: Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey. Pharmacoepidemiol Drug Saf 2012, 21(9):937-44.
• [20]McClean P, Tunney M, Gilpin D, Parsons C, Hughes C: Antimicrobial prescribing in nursing homes in Northern Ireland: results of two point-prevalence surveys. Drugs Aging 2011, 28(10):819-29.
• [21]McClean P, Tunney M, Gilpin D, Parsons C, Hughes C: Antimicrobial prescribing in residential homes. J Antimicrob Chemother 2012, 67(7):1781-90.
• [22]Rummukainen ML, Karki T, Kanerva M, Haapasaari M, Ollgren J, Lyytikainen O: Antimicrobial prescribing in nursing homes in Finland: results of three point prevalence surveys. Infection 2013, 41(2):355-60.
• [23]Blix HS, Roed J, Sti MO: Large variation in antibacterial use among Norwegian nursing homes. Scand J Infect Dis 2007, 39(6-7):536-41.
• [24]Daneman N, Gruneir A, Newman A, Fischer HD, Bronskill SE, Rochon PA, Anderson GM, Bell CM: Antibiotic use in long-term care facilities. J Antimicrob Chemother 2011, 66(12):2856-63.
• [25]Blix HS, Bergman J, Schjott J: How are antibacterials used in nursing homes? Results from a point-prevalence prescription study in 44 Norwegian nursing homes. Pharmacoepidemiol Drug Saf 2010, 19(10):1025-30.
• [26]Pettersson E, Vernby A, Molstad S, Lundborg CS: Infections and antibiotic prescribing in Swedish nursing homes: a cross-sectional study. Scand J Infect Dis 2008, 40(5):393-8.
• [27]Benoit SR, Nsa W, Richards CL, Bratzler DW, Shefer AM, Steele LM, Jernigan JA: Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc 2008, 56(11):2039-44.
• [28]Fagan M, Maehlen M, Lindbaek M, Berild D: Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: compliance with national guidelines. Scand J Prim Health Care 2012, 30(1):10-5.