Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Faculty of Medicine, University of Lausanne, Lausanne, Switzerland.
Communicable Disease Unit, Division of General Cantonal Physician, Geneva Directorate of Health, Geneva, Switzerland; Paediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.
J Hosp Infect. 2024 Nov;153:90-98. doi: 10.1016/j.jhin.2024.09.011. Epub 2024 Sep 30.
Long-term care facility (LTCF) residents are twice as likely to receive antibiotics compared with elderly living in the community, and studies have reported up to half of prescriptions in LTCFs as inappropriate.
To identify factors contributing to general and inappropriate antibiotic prescription among LTCF residents with lower respiratory tract infections (LRTIs).
In this prospective, multicentric, observational study, residents with LRTIs were recruited among 32 LTCFs in Western Switzerland during winter 2022-2023. Residents underwent lung ultrasound (LUS) within three days of LRTI onset, serving as the pneumonia diagnosis reference standard. Multivariate logistic regression and backward selection were used with P < 0.1 cut-off to identify factors among demographics, vital signs, diagnostic tests, and LTCF characteristics associated with (i) antibiotic prescription and (ii) inappropriate prescription.
A total of 114 residents were included, 63% female, median age 87 years. Fifty-nine (52%) residents underwent diagnostic tests: 50 (44%) polymerase chain reaction (PCR) for respiratory viruses and 16 (14%) blood test with C-reactive protein and/or blood count. Sixty-three (55%) residents received antibiotics. Factors associated with antibiotic prescriptions were Rockwood Clinical Frailty Scale score ≥7, oxygen saturation <92%, performing a blood test, rural LTCFs, and female physician. Among residents receiving antibiotics, 48 (74%) had inappropriate prescriptions, with performance of respiratory virus PCR test as the only protective factor.
Whereas half of LRTI residents received antibiotics, falling within lower ranges of European LTCFs prescription rates (53-80%), most antibiotic prescriptions were inappropriate. Utilization of diagnostic tests correlates with lower overall and inappropriate prescription, advocating for their use to optimize prescription practices in LTCFs.
与居住在社区的老年人相比，长期护理机构（LTCF）的居民接受抗生素治疗的可能性要高出两倍，而且有研究报告称，LTCF 中多达一半的处方是不适当的。
确定导致 LTCF 中患有下呼吸道感染（LRTI）的居民接受一般性和不适当抗生素处方的因素。
在这项前瞻性、多中心、观察性研究中，2022-2023 年冬季，在瑞士西部的 32 家 LTCF 中招募了患有 LRTI 的居民。LRTI 发病后 3 天内对居民进行肺部超声（LUS）检查，作为肺炎诊断参考标准。采用多变量逻辑回归和向后选择方法，以 P<0.1 的截止值确定人口统计学、生命体征、诊断检测和 LTCF 特征与（i）抗生素处方和（ii）不适当处方相关的因素。
共纳入 114 名居民，其中 63%为女性，中位年龄为 87 岁。59 名（52%）居民接受了诊断检测：50 名（44%）进行了呼吸道病毒聚合酶链反应（PCR）检测，16 名（14%）进行了 C 反应蛋白和/或血常规检测。63 名（55%）居民接受了抗生素治疗。与抗生素处方相关的因素是 Rockwood 临床虚弱量表评分≥7、血氧饱和度<92%、进行血液检查、农村 LTCF 和女性医生。在接受抗生素治疗的居民中，48 名（74%）的处方不适当，进行呼吸道病毒 PCR 检测是唯一的保护因素。
尽管一半的 LRTI 居民接受了抗生素治疗，这一比例低于欧洲 LTCF 处方率的较低范围（53-80%），但大多数抗生素处方是不适当的。诊断检测的使用与整体和不适当处方的减少相关，这提倡在 LTCF 中使用诊断检测来优化处方实践。
