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Antimicrobial Prescribing in Nursing Homes in Northern Ireland

Results of Two Point-Prevalence Surveys

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Abstract

Background: In 2005, the European Commission recommended that all member states should establish or strengthen surveillance systems for monitoring the use of antimicrobial agents. There is no evidence in the literature of any surveillance studies having been specifically conducted in nursing homes (NHs) in Northern Ireland (NI).

Objective: The aim of this study was to determine the prevalence of antimicrobial prescribing and its relationship with certain factors (e.g. indwelling urinary catheterization, urinary incontinence, disorientation, etc.) in NH residents in NI.

Methods: This project was carried out in NI as part of a wider European study under the protocols of the European Surveillance of Antimicrobial Consumption group. Two point-prevalence surveys (PPSs) were conducted in 30 NHs in April and November 2009. Data were obtained from nursing notes, medication administration records and staff in relation to antimicrobial prescribing, facility and resident characteristics and were analysed descriptively.

Results: The point prevalence of antimicrobial prescribing was 13.2% in April 2009 and 10.7% in November 2009, with a 10-fold difference existing between the NHs with the highest and lowest antimicrobial prescribing prevalence during both PPSs. The same NH had the highest rate of antimicrobial prescribing during both April (30.6%) and November (26.0%). The group of antimicrobials most commonly prescribed was the penicillins (April 28.6%, November 27.5%) whilst the most prevalent individual antimicrobial prescribed was trimethoprim (April 21.3%, November 24.3%). The majority of antimicrobials were prescribed for the purpose of preventing urinary tract infections (UTIs) in both April (37.8%) and in November (46.7%), with 5% of all participating residents being prescribed an antimicrobial for this reason. Some (20%) antimicrobials were prescribed at inappropriate doses, particularly those which were used for the purpose of preventing UTIs. Indwelling urinary catheterization and wounds were significant risk factors for antimicrobial use in April [odds ratio {OR} (95% CI) 2.0 (1.1, 3.5) and 1.8 (1.1, 3.0), respectively] but not in November 2009 [OR (95% CI) 1.6 (0.8, 3.2) and 1.2 (0.7, 2.2), respectively]. Other resident factors, e.g. disorientation, immobility and incontinence, were not associated with antimicrobial use. Furthermore, none of the NH characteristics investigated (e.g. number of beds, hospitalization episodes, number of general practitioners, etc.) were found to be associated with antimicrobial use in either April or November 2009.

Conclusions: This study has identified a high overall rate of antimicrobial use in NHs in NI, with variability evident both within and between homes. More research is needed to understand which factors influence antimicrobial use and to determine the appropriateness of antimicrobial prescribing in this population in general and more specifically in the management of recurrent UTIs.

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Acknowledgements

Funding sources: The ESAC project was funded by the European Centre for Disease Prevention and Control. Pamela McClean is funded by a Department of Employment and Learning studentship and receives additional funding from the Health and Social Care Research and Development, Public Health Agency, Northern Ireland. Michael Tunney is funded as a UK National Career Scientist by the Health and Social Care Research and Development, Public Health Agency, Northern Ireland. The authors’ work was independent of the funders.

Conflicts of interest: The authors have no known conflicts of interest.

Author contributions: Pamela McClean, Carmel Hughes, Michael Tunney, Deirdre Gilpin and Carole Parsons were responsible for study design, analysis, interpretation of the data and preparation of the manuscript. Pamela McClean was responsible for acquisition of subjects and data.

Other contributions: The authors wish to acknowledge the NHs and residents who participated in the study, Beatrice Jans (Institute of Public Health, Brussels, Belgium) and Herman Goossens (Antwerp University, Antwerp, Belgium) for their project coordination support, and Chris Cardwell (Queen’s University Belfast, Northern Ireland) for his statistical assistance.

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  1. School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK

    Pamela McClean, Michael Tunney, Deirdre Gilpin, Carole Parsons &  Carmel Hughes

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  1. Pamela McClean
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Correspondence to Carmel Hughes.

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McClean, P., Tunney, M., Gilpin, D. et al. Antimicrobial Prescribing in Nursing Homes in Northern Ireland. Drugs Aging 28, 819–829 (2011). https://doi.org/10.2165/11595050-000000000-00000

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