National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia; Victorian Healthcare Associated Infection Surveillance System Co-ordinating Centre, Melbourne, VIC, Australia.
Victorian Healthcare Associated Infection Surveillance System Co-ordinating Centre, Melbourne, VIC, Australia.
Am J Infect Control. 2018 Oct;46(10):1148-1153. doi: 10.1016/j.ajic.2018.03.027. Epub 2018 May 18.
Infections in aged care residents are associated with poor outcomes, and inappropriate antimicrobial prescribing contributes to adverse events, such as the emergence of antimicrobial resistance. The objective of this study was to identify resident- and facility-level factors associated with infection and antimicrobial prescribing in Australian aged care residents.
Using data captured by a national point-prevalence survey (the Aged Care National Antimicrobial Prescribing Survey), risk and protective factors were determined by multivariate Poisson regression.
In 2017, 292 facilities were surveyed. Infection prevalence was 2.9% (95% confidence interval [CI], 2.6%-3.2%), and antimicrobial use prevalence was 8.9% (95% CI, 8.4%-9.4%). Resident-level factors associated with infection prevalence included urinary catheterization and hospital admission within the last 30 days; facility-level factors included state and multipurpose service provision. Resident-level factors associated with antimicrobial prescribing included infection signs and symptoms; facility-level factors included state, nonmetropolitan locality, and not-for-profit status. Availability of guidelines for urinary tract infection (UTI) management was associated with reduced antimicrobial prescribing.
Looking ahead, reports should be peer grouped by significant facility-level factors. Priority should be given to implementing UTI management guidelines and prevention of infection in residents with indwelling urinary catheters. Enhanced monitoring and prevention strategies are required for residents recently admitted to hospital.
老年护理居民中的感染与不良结局相关，而不适当的抗菌药物处方会导致不良事件，如抗菌药物耐药性的出现。本研究的目的是确定与澳大利亚老年护理居民感染和抗菌药物处方相关的居民和设施层面的因素。
使用全国性的时点患病率调查（老年护理国家抗菌药物处方调查）中捕获的数据，通过多变量泊松回归确定风险和保护因素。
在 2017 年，对 292 家机构进行了调查。感染患病率为 2.9%（95%置信区间[CI]，2.6%-3.2%），抗菌药物使用率为 8.9%（95%CI，8.4%-9.4%）。与感染患病率相关的居民层面因素包括最近 30 天内导尿和住院；与感染患病率相关的设施层面因素包括州和多用途服务提供。与抗菌药物处方相关的居民层面因素包括感染迹象和症状；与抗菌药物处方相关的设施层面因素包括州、非都市地区和非营利性地位。尿路感染（UTI）管理指南的可用性与抗菌药物处方的减少相关。
展望未来，报告应按重要的设施层面因素进行同行分组。应优先考虑实施 UTI 管理指南，并预防留置导尿管的居民感染。应加强对最近住院居民的监测和预防策略。
