Infection Control and Epidemiology, Southern Health, Melbourne, Victoria, Australia.
Intern Med J. 2012 Oct;42(10):1145-9. doi: 10.1111/j.1445-5994.2012.02796.x.
The prevention and control of transmission of antimicrobial-resistant pathogens in residential aged care facilities (RACF) is an area that has been neglected yet has significant implications for health services.
The aims of this study were to describe the prevalence and appropriateness of antibiotic use within five RACF associated with our health service.
Demographic data on each RACF and all residents were obtained, and antibiotics prescribed (the type, indication and duration) at the time of the survey were recorded. The appropriateness of antibiotic prescribing was assessed using well-established criteria.
Of the 257 residents, 28% were greater than 85 years of age, almost 50% were male and 71% had been in their RACF for more than a year. Sixty-seven per cent were incontinent of urine or faeces, and 80% had some degree of cognitive impairment. Among the residents, 23 (9%) were receiving antibiotics at the time of the survey. Seventeen (74%) were for treatment, while six (26%) were given for prophylactic reasons. Data on the appropriateness of antibiotic use were available for the preceding 26-month period. During this time, there were 988 antibiotic courses administered; of these, 392 (39.7%) did not fulfil the criteria for bacterial infection.
This Australian study is one of the first to report on the use of antibiotics within RACF, shows a high rate of antimicrobial prescribing and inappropriate antibiotic use. Antibiotic stewardship is of paramount importance in RACF. Programmes to promote the rational use of antibiotics and minimise the emergence of resistant pathogens are urgently required in Australian RACF.
住宅养老设施（RACF）中抗微生物耐药病原体的传播的预防和控制是一个被忽视但对卫生服务有重大影响的领域。
本研究的目的是描述与我们的卫生服务相关的五个 RACF 中抗生素使用的流行率和适当性。
获得每个 RACF 和所有居民的人口统计学数据，并记录调查时开具的抗生素（类型、适应证和疗程）。抗生素使用的适当性使用既定标准进行评估。
在 257 名居民中，28%的人年龄大于 85 岁，近 50%为男性，71%在 RACF 中居住超过一年。67%的人尿失禁或粪便失禁，80%的人有一定程度的认知障碍。在居民中，有 23 人（9%）在调查时正在接受抗生素治疗。17 人（74%）是为了治疗，而 6 人（26%）是出于预防原因。抗生素使用适当性的数据可用于前 26 个月。在此期间，共开出 988 个抗生素疗程；其中 392 个（39.7%）不符合细菌感染的标准。
这项澳大利亚研究是首批报告 RACF 中抗生素使用情况的研究之一，显示出高抗菌药物处方率和不适当的抗生素使用。抗生素管理在 RACF 中至关重要。迫切需要在澳大利亚的 RACF 中开展促进抗生素合理使用和减少耐药病原体出现的计划。
