1887
  1. Home
  2. Eurosurveillance
  3. Volume 23, Issue 46, 15/Nov/2018
  4. Article
Research article Open Access
Like 1
Download

Abstract

Background

The 2016 point prevalence survey (PPS) of healthcare-associated infections (HAI) and antimicrobial use (AMU) in Irish long-term care facilities (LTCF) (HALT) showed a 9.8% AMU and 4.4% HAI prevalence, based on aggregated data analysis.

Aim

Our aim was to identify institutional and resident risk factors of AMU and HAI.

Methods

HALT 2016 gathered information using institutional and resident questionnaires, for residents who met the surveillance definition of active HAI and/or AMU, limiting analysis to the aggregated institutional level. In January 2017, we requested additional data on age, sex, urinary catheter use and disorientation of current residents from HALT 2016 LTCF and matched to 2016 HALT data.

Results

Of 224 HALT 2016 LTCF, 80 provided additional information on 3,816 residents; prevalence of AMU was 10.6% and HAI was 4.7%. Presence of a coordinating physician (Odds ratio (OR): 0.3; 95% confidence interval (CI): 0.2–0.6), antimicrobial stewardship committee (OR: 0.2; 95%; CI: 0.1–0.6), healthcare assistants (OR: 0.9; 95% CI: 0.9–1.0), antimicrobial consumption feedback (OR: 0.3; 95% CI: 0.1–0.6) and medical care by personal general practitioner (OR: 0.6; 95% CI: 0.7–1.0) were associated with less AMU and feedback on surveillance of infection prevention and control (IPC) practices (OR: 0.6; 95% CI: 0.3–1.0) with less HAI. AMU and HAI varied significantly between LTCF.

Conclusions

Multilevel modelling identified significant inter-facility variation, as well as institutional factors associated with AMU and HAI. An antimicrobial stewardship committee linked with feedback on IPC and prescribing was associated with reduced AMU and HAI.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2018.23.46.1800278
2018-11-15
2024-11-12
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.46.1800278
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/23/46/eurosurv-23-46-8.html?itemId=/content/10.2807/1560-7917.ES.2018.23.46.1800278&mimeType=html&fmt=ahah

References

  1. Brahma DK, Wahlang JB, Marak MD, Ch Sangma M. Adverse drug reactions in the elderly. J Pharmacol Pharmacother. 2013;4(2):91-4.  https://doi.org/10.4103/0976-500X.110872  PMID: 23761706 
  2. European Centre for Disease Prevention and Control (ECDC). Protocol for point prevalence surveys of healthcare-associated infections and antimicrobial use in European long-term care facilities. Stockholm: ECDC; 2014. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/healthcare-associated-infections-point-prevalence-survey-long-term-care-facilities.pdf
  3. Lim CJ, Kong DCM, Stuart RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interv Aging. 2014;9:165-77. PMID: 24477218 
  4. Strausbaugh LJ, Sukumar SR, Joseph CL, High KP. Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons. Clin Infect Dis. 2003;36(7):870-6.  https://doi.org/10.1086/368197  PMID: 12652388 
  5. Health Protection Surveillance Centre (HPSC). Point prevalence survey of healthcare-associated infections & antimicrobial use in long-term care facilities (HALT): May 2016. Ireland National report –March 2017. HPSC: Dublin; 2017. Available from: http://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2016report/File,16218,en.pdf
  6. Suetens C. Healthcare-associated infections in European long-term care facilities: how big is the challenge? Euro Surveill. 2012;17(35):20259. PMID: 22958606 
  7. Fagan M, Mæhlen M, Lindbæk 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.  https://doi.org/10.3109/02813432.2011.629156  PMID: 22188479 
  8. Crnich CJJ, Jump R, Trautner B, Sloane PD, Mody L, Trautner R, et al. Optimizing antibiotic stewardship in nursing homes: a narrative review and recommendations for improvement. Drugs Aging. 2015;32(9):699-716.  https://doi.org/10.1007/s40266-015-0292-7  PMID: 26316294 
  9. Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57(5):2326-32.  https://doi.org/10.1128/AAC.02176-12  PMID: 23478961 
  10. Ellis C. Long-term antibiotic use may lead to increased risk of cancer. New Jersey: Contagion Live; 2017. Available from: http://www.contagionlive.com/news/long-term-antibiotic-use-may-lead-to-increased-risk-of-cancer#sthash.nmo5WcqW.dpuf
  11. McClean P, Hughes C, Tunney M, Goossens H, Jans B, et al. Antimicrobial prescribing in European nursing homes. J Antimicrob Chemother. 2011;66(7):1609-16.  https://doi.org/10.1093/jac/dkr183  PMID: 21596722 
  12. Daneman N, Bronskill SE, Gruneir A, Newman AM, Fischer HD, Rochon PA, et al. Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents. JAMA Intern Med. 2015;175(8):1331-9.  https://doi.org/10.1001/jamainternmed.2015.2770  PMID: 26121537 
  13. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of health care-associated infections and antimicrobial use in European long-term care facilities. April–May 2013. Stockholm: ECDC; 2014. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/healthcare-associated-infections-point-prevalence-survey-long-term-care-facilities-2013.pdf
  14. Health Protection Surveillance Centre (HPSC). Point prevalence survey of healthcare‐associated infections & antimicrobial use in long‐term care facilities (HALT): May 2013. Republic of Ireland: National report – March 2014. Dublin: HPSC; 2014. Available from: http://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2013report/national2013haltreport/File,14540,en.pdf
  15. Lee C-R, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int J Environ Res Public Health. 2013;10(9):4274-305.  https://doi.org/10.3390/ijerph10094274  PMID: 24036486 
  16. Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17(9):990-1001.  https://doi.org/10.1016/S1473-3099(17)30325-0  PMID: 28629876 
  17. Centers for Disease Control and Prevention (CDC). The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta: CDC; 2015. Available from: http://www.cdc.gov/longtermcare/index.html
  18. European Surveillance of Antimicrobial Consumption (ESAC). ESAC: Results from the national survey of characteristics of nursing homes. ESAC-3: Nursing Home Subproject Group. ESAC; 2009. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/healthtopics/antimicrobial-resistance-and-consumption/antimicrobial-consumption/publications-documents/Documents/ESAC-Net-archive-report_national_survey_characteristics_nursing_homes_2009.pdf
  19. van Buul LW, van der Steen JT, Doncker SM, Achterberg WP, Schellevis FG, Veenhuizen RB, et al. Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study. BMC Geriatr. 2014;14(1):136.  https://doi.org/10.1186/1471-2318-14-136  PMID: 25514874 
  20. Montoya A, Cassone M, Mody L. Infections in Nursing Homes: Epidemiology and Prevention Programs. Clin Geriatr Med. 2016;32(3):585-607.  https://doi.org/10.1016/j.cger.2016.02.004  PMID: 27394025 
  21. Mody L, Crnich C. Effects of Excessive Antibiotic Use in Nursing Homes. JAMA Intern Med. 2015;175(8):1339-41.  https://doi.org/10.1001/jamainternmed.2015.2774  PMID: 26121096 
  22. Chami K, Gavazzi G, Carrat F, de Wazières B, Lejeune B, Piette F, et al. Burden of infections among 44,869 elderly in nursing homes: a cross-sectional cluster nationwide survey. J Hosp Infect. 2011;79(3):254-9.  https://doi.org/10.1016/j.jhin.2011.08.003  PMID: 21899920 
  23. Montoya A, Mody L. Common infections in nursing homes: a review of current issues and challenges. Aging Health. 2011;7(6):889-99.  https://doi.org/10.2217/ahe.11.80  PMID: 23264804 
  24. Health Protection Surveillance Centre (HPSC). European point prevalence survey on healthcare-associated infections and antibiotic use in long-term care facilities. National report – Republic of Ireland. Dublin: HPSC; 2010. Available from: https://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2010report/File,4723,en.pdf
  25. Health Protection Surveillance Centre (HPSC). Second National Prevalence Survey on Healthcare Associated Infections and Antibiotic use in Irish Long-Term Care Facilities. National Report. Dublin: HPSC; 2011. Available from: http://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2011report/File,12869,en.pdf
  26. McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 1991;19(1):1-7.  https://doi.org/10.1016/0196-6553(91)90154-5  PMID: 1902352 
  27. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33(10):965-77.  https://doi.org/10.1086/667743  PMID: 22961014 
  28. Allison PD, Waterman RP. 7. Fixed-Effects Negative Binomial Regression Models. Sociol Methodol. 2002;32(1):247-65.  https://doi.org/10.1111/1467-9531.00117 
  29. Steele F. Module 7(concept): Multilevel models for binary responses. Center for multilevel modelling. Bristol: LEMMA; 2009. Available from: https://www.cmm.bris.ac.uk/lemma/pluginfile.php/2281/mod_resource/content/1/mod-7-concepts.pdf
  30. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):17.  https://doi.org/10.1186/1751-0473-3-17  PMID: 19087314 
  31. Larsen K, Petersen JH, Budtz-Jørgensen E, Endahl L. Interpreting parameters in the logistic regression model with random effects. Biometrics. 2000;56(3):909-14.  https://doi.org/10.1111/j.0006-341X.2000.00909.x  PMID: 10985236 
  32. Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006;60(4):290-7.  https://doi.org/10.1136/jech.2004.029454  PMID: 16537344 
  33. Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol. 2005;161(1):81-8.  https://doi.org/10.1093/aje/kwi017  PMID: 15615918 
  34. Merlo J, Viciana-Fernández FJ, Ramiro-Fariñas DResearch Group of Longitudinal Database of Andalusian Population (LDAP). Bringing the individual back to small-area variation studies: a multilevel analysis of all-cause mortality in Andalusia, Spain. Soc Sci Med. 2012;75(8):1477-87.  https://doi.org/10.1016/j.socscimed.2012.06.004  PMID: 22795359 
  35. Vellinga A, Tansey S, Hanahoe B, Bennett K, Murphy AW, Cormican M. Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: a multilevel model. J Antimicrob Chemother. 2012;67(10):2523-30.  https://doi.org/10.1093/jac/dks222  PMID: 22729920 
  36. Spiegelhalter DJ, Best NG, Carlin BP, Van Der Linde A. Bayesian measures of model complexity and fit. J R Stat Soc Series B Stat Methodol. 2002;64(4):583-639.  https://doi.org/10.1111/1467-9868.00353 
  37. Setia MS. Methodology Series Module 3: Cross-sectional Studies. Indian J Dermatol. 2016;61(3):261-4.  https://doi.org/10.4103/0019-5154.182410  PMID: 27293245 
  38. Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin North Am. 2011;25(1):245-60.  https://doi.org/10.1016/j.idc.2010.11.011  PMID: 21316003 
  39. Dyar OJ, Pagani L, Pulcini C. Strategies and challenges of antimicrobial stewardship in long-term care facilities. Clin Microbiol Infect. 2015;21(1):10-9.  https://doi.org/10.1016/j.cmi.2014.09.005  PMID: 25636921 
  40. Van Schooneveld T, Miller H, Sayles H, Watkins K, Smith PW. Survey of antimicrobial stewardship practices in Nebraska long-term care facilities. Infect Control Hosp Epidemiol. 2011;32(7):732-4.  https://doi.org/10.1086/660855  PMID: 21666410 
  41. McClean P, Tunney M, Gilpin D, Parsons C, Hughes C. Antimicrobial prescribing in residential homes. J Antimicrob Chemother. 2012;67(7):1781-90.  https://doi.org/10.1093/jac/dks085  PMID: 22438433 
  42. Lim CJ, Kwong MW, Stuart RL, Buising KL, Friedman ND, Bennett NJ, et al. Antibiotic prescribing practice in residential aged care facilities--health care providers’ perspectives. Med J Aust. 2014;201(2):98-102. PMID: 25045989 
  43. Zabarsky TF, Sethi AK, Donskey CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control. 2008;36(7):476-80.  https://doi.org/10.1016/j.ajic.2007.11.007  PMID: 18786450 
  44. 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.  https://doi.org/10.1007/s11096-005-1191-5  PMID: 16096881 
  45. Fleming A, Bradley C, Cullinan S, Byrne S. Antibiotic prescribing in long-term care facilities: a meta-synthesis of qualitative research. Drugs Aging. 2015;32(4):295-303.  https://doi.org/10.1007/s40266-015-0252-2  PMID: 25832969 
  46. 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.  https://doi.org/10.1111/j.1532-5415.2005.00470.x  PMID: 16274383 
  47. European Surveillance of Antimicrobial Consumption (ESAC). Report on point prevalence survey of antimicrobial prescription in European nursing homes, November 2009. ESAC; 2011. Available from: http://www.nsih.be/download/LTCF/ESAC-NH/ESAC_EU_NH_Nov09.pdf
  48. Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3(1):23.  https://doi.org/10.1186/2047-2994-3-23  PMID: 25075308 
  49. Health Service Executive (HSE). Guidelines for Antimicrobial Prescribing in Primary Care in Dublin: Health Service Executive; 2012. Available from: http://www.antibioticprescribing.ie
Antimicrobial prescribing and infections in long-term care facilities (LTCF): a multilevel analysis of the HALT 2016 study, Ireland, 2017
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=M+Tandan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tandan M</a>, <a href="/search?value1=K+Burns&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Burns K</a>, <a href="/search?value1=H+Murphy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Murphy H</a>, <a href="/search?value1=S+Hennessy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hennessy S</a>, <a href="/search?value1=M+Cormican&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cormican M</a>, <a href="/search?value1=A+Vellinga&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vellinga A</a></span>. Antimicrobial prescribing and infections in long-term care facilities (LTCF): a multilevel analysis of the HALT 2016 study, Ireland, 2017. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(46):pii=1800278. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800278" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800278</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 24 May 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 05 Nov 2018 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.46.1800278
/content/10.2807/1560-7917.ES.2018.23.46.1800278
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error