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Antimicrobial prescribing and infections in long-term care facilities (LTCF): a multilevel analysis of the HALT 2016

M Tandan1, K Burns2,3, H Murphy2

  • 1Discipline of General Practice, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland.

Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin
|November 22, 2018
PubMed

Insights

Implementing antimicrobial stewardship committees and providing feedback on infection prevention and control (IPC) practices in long-term care facilities (LTCF) significantly reduced antimicrobial use (AMU) and healthcare-associated infections (HAI). These findings highlight key institutional factors for reducing AMU and HAI in LTCF.

Area of Science:

  • Gerontology
  • Infectious Diseases
  • Public Health

Background:

  • The 2016 Irish point prevalence survey (HALT) identified significant antimicrobial use (AMU) and healthcare-associated infections (HAI) in long-term care facilities (LTCF).
  • Previous analysis relied on aggregated data, limiting the identification of specific risk factors.

Purpose of the Study:

  • To identify institutional and resident-level risk factors associated with AMU and HAI in Irish LTCF.
  • To analyze the impact of specific facility characteristics on AMU and HAI prevalence.

Main Methods:

  • Utilized data from the 2016 HALT survey, supplemented with resident-specific information (age, sex, catheter use, disorientation) collected in 2017.
  • Employed multilevel modeling to analyze variations in AMU and HAI across 80 participating LTCF, involving 3,816 residents.

Main Results:

  • Antimicrobial use (AMU) prevalence was 10.6% and HAI prevalence was 4.7% in the analyzed subset of LTCF.
  • Key factors associated with reduced AMU included the presence of a coordinating physician, an antimicrobial stewardship committee, and feedback on antimicrobial consumption.
  • Feedback on infection prevention and control (IPC) surveillance was linked to reduced HAI.

Conclusions:

  • Significant inter-facility variations in AMU and HAI exist within LTCF.
  • Institutional factors, particularly antimicrobial stewardship programs and IPC feedback, are crucial for mitigating AMU and HAI.
  • Establishing an antimicrobial stewardship committee integrated with IPC and prescribing feedback can effectively reduce both AMU and HAI in LTCF.
Keywords:
HAIHALTIrelandLTCFantibiotic useantimicrobialantimicrobial resistanceelderlyhealthcare-associated infectionsinfection controlinfectionsmodellingmultidrug resistancemultilevelsurveillance

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