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Trends in microbiology testing in Australian long-term care facilities: national cohort study
Yohanes A Wondimkun1,2, Maria C Inacio3,4, Peter Lekkas5
1School of Allied Health and Human Performance, College of Health, Adelaide University, Adelaide, South Australia, Australia. yohanes.wondimkun@adelaide.edu.au.
Background:
Microbiology testing can guide infectious disease management and antimicrobial selection, including for older people living in long-term care facilities (LTCFs), who are at high risk of infectious diseases. However, insufficient and excessive microbiology testing can contribute to inappropriate antimicrobial use. The study examined national trends, co-testing, and LTCF variation in microbiology testing.
Methods:
This national repeated cross-sectional study included individuals aged 65-105 years residing in Australian LTCFs between 2009 and 2019. The annual age and sex standardised (i) proportion of individuals with a microbiology test and (ii) number of tests performed/100 resident-years were determined. Annual changes were estimated using adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) from Poisson or negative binomial models. Co-testing and LTCF variation in 2019 were also evaluated.
Results:
Among the 547,067 studied residents, the median age at study entry was 84 years and 65.8% were women. Proportion of microbiology testing increased from 50.2% (95%CI 49.8-50.5) in 2009 to 59.4% (95%CI 59.0-59.7) in 2019 (aRR 1.02, 95%CI 1.01-1.02). Urine tests were the most frequently requested microbiology test, increasing from 40.9% (95%CI 40.5-41.2) to 44.9% (95%CI 44.5-45.2) during 2009-2019 (aRR 1.01, 95%CI 1.01-1.01). Nucleic acid amplification tests (NAATs) increased from 3.4% (95%CI 3.3-3.5) to 17.9% (95%CI 17.7-18.1) (aRR 1.21, 95%CI 1.21-1.21). In 2019, there were 1,614 (58.6%) LTCFs where the adjusted proportion of microbiology testing fell within the 95%CI range around the population mean. Faecal, Cryptosporidium/Giardia, and Clostridioides difficile/C.toxin tests were commonly performed concurrently with NAATs.
Conclusions:
Over an 11-year period, microbiology testing increased. Eight out of ten residents were tested at least once during their LTCF stay, and considerable facility variation in testing was observed. Diagnostic stewardship targeting commonly requested microbiology tests (e.g., urine tests) could optimise antimicrobial use in LTCFs.
Insights
Microbiology testing in aged care increased from 2009-2019, with urine tests and nucleic acid amplification tests (NAATs) showing significant growth. Diagnostic stewardship can optimize antimicrobial use in long-term care facilities (LTCFs).
Area of Science:
- Gerontology
- Infectious Diseases
- Clinical Microbiology
Background:
- Microbiology testing is crucial for managing infections and guiding antimicrobial selection in long-term care facilities (LTCFs).
- Both under-testing and over-testing can lead to inappropriate antimicrobial use in this vulnerable population.
- This study investigated national trends in microbiology testing, including co-testing patterns and variations among LTCFs.
Purpose of the Study:
- To analyze national trends in microbiology testing rates among Australian residents aged 65-105 years in LTCFs from 2009 to 2019.
- To examine changes in the proportion of individuals tested and the number of tests performed per resident.
- To evaluate co-testing practices and facility-level variations in microbiology testing in 2019.
Main Methods:
- A national repeated cross-sectional study design was employed, analyzing data from 547,067 residents in Australian LTCFs.
- Annual age and sex standardized proportions of individuals tested and tests per 100 resident-years were calculated.
- Adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) were estimated using Poisson or negative binomial models to assess annual changes.
Main Results:
- Microbiology testing increased from 50.2% in 2009 to 59.4% in 2019 (aRR 1.02).
- Urine tests remained the most frequent, increasing from 40.9% to 44.9% (aRR 1.01), while nucleic acid amplification tests (NAATs) saw a substantial rise from 3.4% to 17.9% (aRR 1.21).
- In 2019, considerable variation in testing rates was observed across LTCFs, with some common co-testing patterns noted.
Conclusions:
- Microbiology testing rates among LTCF residents in Australia increased over the 11-year study period.
- A significant proportion of residents underwent testing, but substantial variation existed between facilities.
- Targeted diagnostic stewardship interventions focusing on common tests like urine analyses are recommended to optimize antimicrobial prescribing in LTCFs.
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