Antimicrobial Prescribing in Nursing Homes in Northern Ireland Results of Two Point-Prevalence Surveys
Antimicrobial Prescribing in Nursing Homes in Northern Ireland Results of Two Point-Prevalence Surveys
复制标题
DOI：
10.2165/11595050-000000000-00000
复制
发表时间：
2011-01-01
期刊：
影响因子：
2.8
通讯作者：
Hughes, Carmel
中科院分区：
文献类型：
--
作者：
McClean, Pamela;Tunney, Michael;Hughes, Carmel
背景：2005年，欧盟委员会建议所有成员国建立或加强监测抗菌药物使用的监测系统。文献中没有证据表明在北爱尔兰 (NI) 的疗养院 (NH) 中专门进行过任何监测研究。目的：本研究的目的是确定北爱尔兰 (NI) 疗养院居民中抗菌药物处方的流行情况及其与某些因素（例如留置导尿管、尿失禁、迷失方向等）的关系。方法：该项目是在北爱尔兰开展的，作为欧洲监测方案下更广泛的欧洲研究的一部分。抗菌药物消耗组。 2009 年 4 月和 11 月，在 30 个 NH 进行了两次点流行率调查 (PPS)。从护理记录、用药管理记录和工作人员中获得了与抗菌药物处方、设施和居民特征相关的数据，并进行了描述性分析。结果：抗菌药物处方点流行率在 2009 年 4 月和 2009 年 11 月分别为 13.2% 和 10.7%，两者之间存在 10 倍的差异。两次 PPS 期间抗菌药物处方率最高和最低的 NH。同一 NH 在 4 月（30.6%）和 11 月（26.0%）期间抗菌药物处方率最高。最常用的抗菌药物是青霉素（4 月 28.6%，11 月 27.5%），而最常用的个人抗菌药物是甲氧苄啶（4 月 21.3%，11 月 24.3%）。在 4 月（37.8%）和 11 月（46.7%），大多数抗菌药物的使用目的是预防尿路感染 (UTI)，其中 5% 的参与居民因此而服用抗菌药物。一些（20%）抗菌药物的处方剂量不适当，特别是那些用于预防尿路感染的抗菌药物。 4月份留置导尿管和伤口是抗菌药物使用的重要危险因素[比值比{OR} (95% CI)分别为2.0 (1.1, 3.5)和1.8 (1.1, 3.0)]，但在2009年11月则不是[OR (95% CI)分别为1.6 (0.8, 3.2)和1.2 (0.7, 2.2)]。其他居民因素，例如定向障碍、行动不便和失禁与抗菌药物的使用无关。此外，所调查的 NH 特征（例如床位数量、住院次数、全科医生人数等）均未发现与 2009 年 4 月或 11 月的抗菌药物使用相关。结论：本研究发现 NI NH 中抗菌药物的总体使用率较高，家庭内部和家庭之间的差异很明显。需要更多的研究来了解哪些因素影响抗菌药物的使用，并确定抗菌药物处方在这一人群中的适当性，更具体地说是在治疗复发性尿路感染方面。
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.