Improving Antimicrobial Prescribing: A Multinomial Model Identifying Factors Associated With First- and Second-Line...

Area of Science:

• Infectious Diseases
• Pharmacology
• Geriatrics

Background:

• Antimicrobial resistance is a growing global health concern.
• Appropriate antimicrobial selection is crucial, especially in vulnerable populations like nursing home residents.
• Second-line antimicrobials are often used when first-line treatments fail, but their overuse can contribute to resistance.

Purpose of the Study:

• To compare antimicrobial prescribing practices in long-term care facilities.
• To identify factors influencing the prescription of first-line versus second-line antimicrobials.
• To assess the impact of antimicrobial stewardship education on prescribing patterns.

Main Methods:

• A point prevalence survey of healthcare-associated infections and antimicrobial use was conducted in Irish long-term care facilities (HALT study).
• Data from 77 facilities and 3677 residents were analyzed.
• Multilevel multinominal logistic regression was used to identify factors associated with first-line, second-line, or no antimicrobial prescriptions.

Main Results:

• Of residents prescribed antimicrobials, 46% received second-line agents.
• Significant interfacility variation in second-line antimicrobial prescribing was observed.
• Facilities providing antimicrobial prescribing education used significantly less second-line antimicrobials (OR=0.2).
• Male residents were less likely to receive first-line antimicrobials, while females and those with urinary catheters were more likely.

Conclusions:

• Second-line antimicrobial prescribing is prevalent in long-term care facilities.
• Antimicrobial stewardship education is a key factor in reducing the use of second-line agents.
• Reducing second-line antimicrobial use can improve patient outcomes and mitigate antimicrobial resistance.