Discipline of General Practice, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland.
Discipline of Pharmacology, School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland.
Euro Surveill. 2019 Mar;24(11). doi: 10.2807/1560-7917.ES.2019.24.11.1800102.
BackgroundLong-term care facilities (LTCFs) are important locations of antimicrobial consumption. Of particular concern is inappropriate prescribing of prophylactic antimicrobials. AimWe aimed to explore factors related to antimicrobial prophylaxis in LTCFs in Ireland. MethodsThe point prevalence surveys of Healthcare-Associated Infections in Long-Term Care Facilities (HALT) were performed in Ireland in May 2013 and 2016. Data were collected on facility (type and stewardship initiatives) and resident characteristics (age, sex, antimicrobial and indication) for those meeting the surveillance definition for a HAI and/or prescribed an antimicrobial. ResultsIn 2013, 9,318 residents (in 190 LTCFs) and in 2016, 10,044 residents (in 224 LTCFs) were included. Of the 10% of residents prescribed antimicrobials, 40% were on prophylaxis, most of which was to prevent urinary tract infection. The main prophylactic agents were: nitrofurantoin (39%) and trimethoprim (41%) for urinary tract (UT); macrolides (47%) for respiratory tract and macrolides and tetracycline (56%) for skin or wounds. More than 50% of the prophylaxis was prescribed in intellectual disability facilities and around 40% in nursing homes. Prophylaxis was recorded more often for females, residents living in LTCFs for more than 1 year and residents with a urinary catheter. No difference in prophylactic prescribing was observed when comparing LTCFs participating and not participating in both years. ConclusionsForty per cent of antimicrobial prescriptions in Irish LTCFs were prophylactic. This practice is not consistent with national antimicrobial prescribing guidelines. Addressing inappropriate prophylaxis prescribing in Irish LTCFs should be a key objective of antimicrobial stewardship initiatives.
长期护理机构（LTCF）是抗菌药物使用的重要场所。尤其需要关注的是预防性使用抗菌药物的不合理情况。目的：我们旨在探索爱尔兰 LTCF 中与抗菌药物预防相关的因素。方法：2013 年 5 月和 2016 年 5 月在爱尔兰开展了长期护理机构医源性感染的点患病率调查（HALT）。对符合医源性感染监测定义和/或接受抗菌药物治疗的患者，收集了有关机构（类型和管理举措）和患者特征（年龄、性别、抗菌药物和适应证）的数据。结果：2013 年，共纳入 190 家 LTCF 的 9318 名患者，2016 年，共纳入 224 家 LTCF 的 10044 名患者。在所调查的接受抗菌药物治疗的患者中，10%接受了预防治疗，其中大多数是为了预防尿路感染。主要的预防用药物包括：治疗尿路感染（UT）时用的呋喃妥因（39%）和甲氧苄啶（41%）；治疗呼吸道感染时用的大环内酯类（47%）；治疗皮肤或伤口感染时用的大环内酯类和四环素（56%）。在智力障碍患者护理机构中，有超过 50%的患者接受了预防治疗，在护理院中有近 40%的患者接受了预防治疗。接受预防治疗的患者中，女性、在 LTCF 居住时间超过 1 年的患者以及有导尿管的患者比例更高。在比较连续两年参与和未参与的 LTCF 时，并未观察到预防用抗菌药物处方的差异。结论：爱尔兰 LTCF 中 40%的抗菌药物处方是预防性的。这种做法与国家抗菌药物处方指南不一致。解决爱尔兰 LTCF 中不合理的预防性抗菌药物处方应成为抗菌药物管理举措的主要目标。
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