A comparative analysis of prophylactic antimicrobial use in long-term care facilities in Ireland, 2013 and 2016

Abstract

BackgroundLong-term care facilities (LTCFs) are important locations of antimicrobial consumption. Of particular concern is inappropriate prescribing of prophylactic antimicrobials. AimWe aimed to explore factors related to antimicrobial prophylaxis in LTCFs in Ireland. MethodsThe point prevalence surveys of Healthcare-Associated Infections in Long-Term Care Facilities (HALT) were performed in Ireland in May 2013 and 2016. Data were collected on facility (type and stewardship initiatives) and resident characteristics (age, sex, antimicrobial and indication) for those meeting the surveillance definition for a HAI and/or prescribed an antimicrobial. ResultsIn 2013, 9,318 residents (in 190 LTCFs) and in 2016, 10,044 residents (in 224 LTCFs) were included. Of the 10% of residents prescribed antimicrobials, 40% were on prophylaxis, most of which was to prevent urinary tract infection. The main prophylactic agents were: nitrofurantoin (39%) and trimethoprim (41%) for urinary tract (UT); macrolides (47%) for respiratory tract and macrolides and tetracycline (56%) for skin or wounds. More than 50% of the prophylaxis was prescribed in intellectual disability facilities and around 40% in nursing homes. Prophylaxis was recorded more often for females, residents living in LTCFs for more than 1 year and residents with a urinary catheter. No difference in prophylactic prescribing was observed when comparing LTCFs participating and not participating in both years. ConclusionsForty per cent of antimicrobial prescriptions in Irish LTCFs were prophylactic. This practice is not consistent with national antimicrobial prescribing guidelines. Addressing inappropriate prophylaxis prescribing in Irish LTCFs should be a key objective of antimicrobial stewardship initiatives.

Keywords: antimicrobial; long-term care facilities, HALT; prescribing; prophylaxis.

Figure 1

Proportion of residents prescribed prophylactic antimicrobials, by body site targeted, healthcare-associated infections in long-term care facilities point prevalence surveys, Ireland, 2013 and 2016, (A) in long-term care facilities which participated in both surveys (n=119) and (B) in long-term care facilities which participated in either survey (n = 190 in 2013 and n = 224 in 2016)

Figure 2

Breakdown of antimicrobial agents’ prophylaxis by top three body sites, healthcare-associated infections in long-term care facilities point prevalence surveys, Ireland, 2013 and 2016