Abstract
Objectives
The objective of this study is to describe antibacterial use in long-term care facilities
and to investigate the determinants of use.
Design
This study is a quality improvement study conducted from January 2011 to December 2016.
Setting
Long-term care facilities in the canton of Vaud, Western Switzerland, were investigated.
Participants
Twenty-three long-term care facilities were included in this study.
Intervention
The intervention included the publication of local guidelines on empirical antibacterial
therapy and the implementation of physician-pharmacist-nurse quality circles.
Measures
The main outcome was antibacterial use, expressed as defined daily doses (DDD) per
1000 beds per day. Statistical analyses were performed through a 1-level mixed model
for repeated measurements.
Results
Antibacterial use decreased from 45.6 to 35.5 DDD per 1000 beds per day (−22%, P < .01) over the 6-year study period, which was mostly explained by reduced fluoroquinolone
use (−59%, P < .001). A decrease in range of use among LTCFs was observed during the study period,
and 27% of antibacterial use was related to the WATCH group (antibiotics with higher
toxicity concerns and/or resistance potential) according to the AWaRe categorization
of the WHO, decreasing from 17.3 DDD per 1000 beds per day to 9.5 (−45%) over the
study period. The use of antibacterials from the RESERVE group (“last-resort” treatment
options) was very low.
Conclusion and implications
A reduction in facility-level antibacterial use and in variability across LTCFs was
observed over the study period. The dissemination of empirical antibacterial prescription
guidelines and the implementation of physician-pharmacist-nurse quality circles in
all LTCFs of the canton of Vaud likely contributed to this reduction. Antibacterials
from the WATCH group still represented 27% of the total use, providing targets for
future antibiotic stewardship activities.
Keywords
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Article Info
Publication History
Published online: July 18, 2019
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
