Journal of the American Medical Directors Association
Original StudyAntibiotic Prescribing In Dutch Nursing Homes: How Appropriate Is It?
Section snippets
Study Setting
The study was conducted in 10 NHs participating in a research project aimed at rationalizing antibiotic prescribing in LTCFs: the Improving Rational Prescribing of Antibiotics in Long-term Care Facilities (IMPACT) study.18 The current study comprises a baseline measurement, ahead of any intervening to improve antibiotic prescribing. Table 1 summarizes the recruitment of study facilities. Eight NHs were located in urban areas, and 2 were located in rural areas, all in the central-west region of
Demographics
The 10 participating NHs had a mean of 163 beds per facility (range: 67–228) and a mean bed occupancy of 97% (range: 93%–100%). On average, 51% of beds were for psychogeriatric patients (ie, mostly with dementia; range: 0%–78%), 32% for somatic patients (ie, with physical disability; range: 17%–72%), and 17% for rehabilitation patients (range: 0%–35%). In total, 707 consultations for 525 residents were registered by 62 physicians. Of these consultations, 406 (57%) were for UTI, 247 (35%) for
Discussion
We investigated the appropriateness of decisions to prescribe or withhold antibiotics in Dutch NHs and found that 76% of these decisions were appropriate. Treatment decisions were less often appropriate for UTI compared with decisions for RTI and SI. Decisions were more often appropriate when antibiotics were withheld compared with when antibiotics were prescribed, which indicates that overprescribing occurs more frequently than underprescribing. The most common clinical situations in which
Conclusion
Our findings suggest that more appropriate treatment decisions can lead to decreased antibiotic consumption in NHs in the Netherlands, as inappropriate treatment decisions were more often related to overuse than underuse of antibiotics. Appropriateness of treatment decisions can be improved by focusing on reduced antibiotic prescribing for asymptomatic bacteriuria, and to a lesser extent for viral RTI. Interventions directed at these conditions, thereby taking into account the many factors
Acknowledgments
We acknowledge the following persons: Philip D. Sloane and Sheryl Zimmerman (University of North Carolina at Chapel Hill), for their contribution to the conception and design of the IMPACT study; Sarah M.M.M. Doncker, for her contribution to data collection; Giselka Gutschow, for her contribution to data processing; and Jochen W. Cals, Susanne E. Geerlings, Marlies E.J.L. Hulscher, Marianne A.B. van der Sande, Paul B.M. Went, Ellen E. Stobberingh, John E. Degener, Inge C. Gyssens, Theo J.M.
References (36)
- et al.
Antibiotic use and resistance in long term care facilities
J Am Med Dir Assoc
(2012) - et al.
Clinical uncertainties in the approach to long-term care residents with possible urinary tract infection
J Am Med Dir Assoc
(2014) - et al.
Definitions of infection for surveillance in long-term care facilities
Am J Infect Control
(1991) - et al.
Variation in antibiotic use in the European Union
Lancet
(2001) - et al.
Appropriateness of antibiotic therapy in long-term care facilities
Am J Med
(1987) - et al.
Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention
Am J Infect Control
(2008) - et al.
Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee
Infect Control Hosp Epidemiol
(2000) - et al.
Resistant bacteria in nursing homes: A rational approach
Hosp Pract (1995)
(1996) - et al.
Multidrug-resistant gram-negative bacteria in a long-term care facility: Prevalence and risk factors
J Am Geriatr Soc
(2008) - et al.
Systemic antibiotic use in nursing homes. A quality assessment
J Am Geriatr Soc
(1986)
Antimicrobial use in nursing homes in Manitoba
J Geriatr Drug Ther
Antibiotic use and misuse in residential aged care facilities
Intern Med J
Surveillance of infection burden in residential aged care facilities
Med J Aust
Antibiotic use in Ontario facilities that provide chronic care
J Gen Intern Med
Another setting for stewardship: High rate of unnecessary antimicrobial use in a Veterans Affairs long-term care facility
J Am Geriatr Soc
Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections
J Am Geriatr Soc
Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes
Arch Intern Med
Patterns of antimicrobial use for respiratory tract infections in older residents of long-term care facilities
J Am Geriatr Soc
Cited by (73)
Prevalence of healthcare-associated infections in Dutch long-term care facilities from 2009 to 2019
2024, Journal of Hospital InfectionUse of a Telemedicine Team to Improve Guideline-Based Antibiotic Prescribing
2022, Journal of the American Medical Directors AssociationCitation Excerpt :Decreasing inappropriate prescriptions relied on the educational effect of feedback on previous prescribing behavior. An earlier study by Van Buul et al found higher (76% compared to 40%) percentages of appropriate antibiotic prescriptions (68% UTI, 87% RTI, and 94% SSTI).26 However, Van Buul et al investigated appropriateness of decisions to prescribe or withhold antibiotics, whereas our results concern only infection episodes where antibiotics were already prescribed.
Clinical Reasoning Underlying Guideline Nonadherence in Urinary Tract Infections in Nursing Homes
2022, Journal of the American Medical Directors AssociationAn Electronic Health Record Integrated Decision Tool and Supportive Interventions to Improve Antibiotic Prescribing for Urinary Tract Infections in Nursing Homes: A Cluster Randomized Controlled Trial
2022, Journal of the American Medical Directors AssociationCitation Excerpt :Randomization was performed by an independent statistician by using randomization software. We considered an increase of at least 20% appropriate antibiotic prescribing for suspected UTI to be clinically relevant.2 To detect this difference with 80% power and a significance level of 5%, 72 cases of antibiotic prescribing for UTI would be required in each group.19
Effectiveness of a tailored intervention to reduce antibiotics for urinary tract infections in nursing home residents: a cluster, randomised controlled trial
2021, The Lancet Infectious DiseasesCitation Excerpt :In European nursing homes, urinary tract infections (UTIs) account for most antibiotic prescriptions, but the majority are regarded as inappropriate.1,2
Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland
2021, Journal of Hospital InfectionCitation Excerpt :Indeed, one recent review revealed that nearly half of the antibiotics that are prescribed in LTCFs are not necessary, and that antibiotic stewardship is key in LTCFs [9]. The purpose of the present survey was not to evaluate the appropriateness of the antibiotic treatment; this could be evaluated in further studies as data from the Netherlands show that antibiotic consumption could be reduced if appropriateness is improved, particularly for UTIs [21]. Nevertheless, given that the prevalence of HAIs was higher than the prevalence of antibiotic use, it is likely that most treatments were appropriate, at least in terms of the indication.
The authors declare no conflicts of interest.
This study was funded by a grant from The Netherlands Organisation for Health Research and Development (ZonMw, The Hague; grant number 205 100011).