Use of antibiotics for urinary tract infections up to and after care home admission in Denmark: a nationwide study

Abstract

Purpose: Older people have the highest use of antibiotics for acute and chronic urinary tract infection (UTI), despite diagnostic uncertainty and the growing problem of antibiotic resistance. We aim to describe use-patterns of UTI antibiotics two years prior to and following care home admission in Denmark.

Methods: This was a register-based nationwide drug-utilization study. In a cohort comprising all Danish residents admitted into a care home from 2015 to 2021, we described the use of UTI antibiotics, and examined differences between regions and individual care homes in rates of UTI antibiotic use. Further, we described trends in UTI-related contacts with hospitals in the two years prior to and following care home admission.

Results: The cohort comprised 101,297 residents (61% female; median age 84 years). UTI antibiotic use doubled from 7 to 14 treatments/100 residents/month two months prior to care home admission and remained at 10 treatments/100 residents/month the following two years. Prescription of pivmecillinam (55%) was most common. Primary care practitioners prescribed the majority (92%) of UTI antibiotics. UTI-related hospital contacts peaked at two months prior to care home admission, with 6 admissions/100 residents/month, subsequently dropping to 2 admission/100 residents/month. We found considerable variation in UTI antibiotic use, with 10% of care homes responsible for 20% of treatments in 2021.

Conclusion: Use of UTI antibiotics increased prior to and remained at a stable high level following care home admission in Denmark. Despite variation in use across regions and individual care homes, an overall decrease was seen throughout the years 2016-2021.

Keywords: Antibiotics; Care home; Drug utilization; Older people; Urinary tract infection.

Fig. 1

Number of treatment episodes per month per 100 residents in the 2 years leading up to and following care home admission and specified by type of antibiotic. A treatment episode was defined as the filling of a prescription for a urinary tract infection specific antibiotic ≥ 15 days after a previous prescription

Fig. 2

Differences in use of urinary tract infections antibiotics between the five regions of Denmark, during 2016 to 2021. Represented by average number of treatments per person-year per region, standardized by sex and age to the overall population. A treatment episode was defined as the filling of a prescription for a UTI antibiotic ≥ 15 days after a previous prescription

Fig. 3

Differences in the use of urinary tract infections antibiotic treatments between different care homes during the year 2021 in Denmark. A treatment episode was defined as the filling of a prescription for a UTI antibiotic ≥ 15 days after a previous prescription

Fig. 4

Total hospital contacts due to urinary tract infections related admissions in the two years leading up to and following care home admissions. UTI-associated contacts were defined by using the Danish National Patient Registry and the ICD-10 codes; cystitis (ICD-10: N30.X and N39.0); pyelonephritis (ICD-10: N10.X, N11.X and N12.X); observation due to suspected UTI (ICD-10: Z038A and Z038B); and urosepsis (ICD-10: A419B)