Antibiotic use in long-term care facilities
Antibiotic use in long-term care facilities
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DOI：
10.1093/jac/dkr395
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发表时间：
2011-12-01
影响因子：
5.2
通讯作者：
Bell, Chaim M.
中科院分区：
文献类型：
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作者：
Daneman, Nick;Gruneir, Andrea;Bell, Chaim M.
目的：评估和优化抗生素使用(抗生素管理)作为一种减少机构内抗生素耐药性、不良事件、治疗并发症和成本的手段正日益得到推广。我们的目标是检查长期护理机构居民中抗生素使用的流行率以及这些机构之间的差异程度。方法：我们使用加拿大最大省份的链接医疗数据库，于2009年4月至6月期间对居住在安大略省长期护理机构(n=363机构)的老年人(n=37371)进行了一项基于人群的点流行率研究。根据机构的平均抗生素配发率将机构分组为五分位数，并比较五分位数之间的差异。结果：在研究日期，2190名长期护理居民(5.9%)接受了抗生素处方。最常见的3种抗生素是最常用于治疗尿路感染的药物，包括呋喃妥因(365例，15.4%)、甲氧苄啶/磺胺甲恶唑(338例，14.3%)和环丙沙星(304例，12.8%)。大多数疗程至少10天(1482例，62.6%)，许多疗程超过90天(495例，20.9%)，提示慢性预防。不同机构的抗生素使用有很大的差异，从使用最高的五分位数(10.8%)到使用最低的五分位数(2.2%)，相差5倍。在调整了多个设施水平和居民水平的因素后，这种差异仍然存在，包括人口统计特征、医疗保健利用统计数据、共病患病率、功能状况和设备依赖。结论：抗生素的使用在长期护理居民中很常见，在不同机构之间存在差异，并可能受益于有针对性的抗菌药物管理干预，以规范治疗适应症和持续时间。
Objectives: Evaluation and optimization of antibiotic use (antibiotic stewardship) is being increasingly promoted as a means to reduce antibiotic resistance, adverse events, treatment complications and costs within institutions. Our goal was to examine the prevalence of antibiotic use among long-term care facility residents and the extent of variability across these institutions.Methods: We conducted a population-based, point-prevalence study of antibiotic use among elderly individuals (n=37371) residing in long-term care facilities (n=363 institutions) in Ontario between April and June 2009, using linked healthcare databases from Canada's largest province. Facilities were grouped into quintiles according to their mean antibiotic dispensing rates and variation was compared across quintiles.Results: There were 2190 (5.9%) long-term care residents receiving antibiotic prescriptions on the study date. The three most prevalent antibiotics were agents most commonly used for the treatment of urinary tract infections, including nitrofurantoin (365, 15.4%), trimethoprim/sulfamethoxazole (338, 14.3%) and ciprofloxacin (304, 12.8%). The majority of treatment courses were at least 10 days in duration (1482, 62.6%), and many exceeded 90 days (495, 20.9%), suggesting chronic prophylaxis. There was substantial variability in antibiotic use across facilities, with a 5-fold variation from the highest-use quintile (10.8%) to the lowest-use quintile (2.2%). This variation persisted after adjustment for multiple facility-level and resident-level factors, including demographic characteristics, healthcare utilization statistics, co-morbidity prevalence, functional status and device dependence.Conclusions: Antibiotic use is common among long-term care residents, variable across institutions, and may benefit from focused antimicrobial stewardship interventions to standardize treatment indications and duration.