Department of Geriatrics, APHP Bichat Hospital, University Paris Cité, Paris, France.
Infectious Diseases Department, APHP Bichat Hospital, University Paris Cité, Paris, France.
Antimicrob Resist Infect Control. 2024 Nov 27;13(1):142. doi: 10.1186/s13756-024-01487-1.
Overuse of antibiotics is frequent in nursing homes (NHs) leading to adverse events and selection of resistant bacteria. Antimicrobial stewardship interventions showed heterogeneous effects on reducing inappropriate use of antimicrobials in NHs.
This study aimed (1) to analyze antimicrobial prescribing determinants in NHs; (2) to identify which resources for antimicrobial prescribing are used by NHs' physicians (3) understand which antimicrobial stewardship interventions are required and how they should be implemented in NHs.
We conducted individual semi-directed interviews with NHs' prescribing physicians in Ile-de-France, France. A thematic content analysis was conducted iteratively.
Thirteen interviews were conducted. Participants were mostly women, with a median age of 48 years and a median professional experience in NHs of three years. Participants included medical coordinators, general practitioners and salaried physicians. Main determinants of antimicrobial prescribing in NHs were the perceived risk of infectious complications and discomfort in residents, the difficulty in obtaining microbiological samples and the lack of healthcare professionals to monitor patients. Most participants reported using national guidelines and electronic decision support systems to guide their antimicrobial prescribing. Institutional constraints accentuate situations of doubt and prompt physicians to prescribe antimicrobials "just in case" despite the will to follow guidelines and the known risks of antimicrobial misuse. Physicians stated that proper antimicrobial use in NHs would require a major effort but was not judged a priority as compared to other medical issues. Producing guidelines tailored to the NH's context, performing good practice audits with feedback on antimicrobial prescribing, and reinforcing multidisciplinary relationships and discussions between city and hospital professionals were cited as potential interventions. The role of the medical coordinator was described as central. According to physicians, collaboration among stakeholders, providing support and training during the process might prove effective strategies to ensure successful implementation.
Antimicrobial prescribing is a complex decision-making process involving different factors and actors in NHs. Tailored guidelines, good practice audits, strengthened multidisciplinary collaboration were proposed as key AMS interventions. Physicians emphasized the central role of the medical coordinator supported by stakeholder engagement, collaboration, training and ongoing support for successful implementation.
养老院（NHs）中抗生素的过度使用导致不良事件和耐药菌的选择。抗菌药物管理干预措施对减少 NHs 中抗菌药物的不合理使用显示出不同的效果。
本研究旨在（1）分析 NHs 中抗菌药物处方的决定因素；（2）确定 NHs 医生使用哪些资源进行抗菌药物处方；（3）了解 NHs 需要哪些抗菌药物管理干预措施以及应如何实施。
我们在法国法兰西岛对 NHs 的处方医生进行了个人半定向访谈。采用主题内容分析法进行迭代分析。
共进行了 13 次访谈。参与者主要是女性，中位年龄为 48 岁，在 NHs 的中位专业经验为三年。参与者包括医疗协调员、全科医生和受薪医生。NHs 中抗菌药物处方的主要决定因素是对感染性并发症和居民不适的感知风险、获得微生物样本的困难以及缺乏监测患者的医疗保健专业人员。大多数参与者报告说，他们使用国家指南和电子决策支持系统来指导他们的抗菌药物处方。机构限制加剧了疑虑的情况，并促使医生在明知抗生素滥用风险的情况下“以防万一”而开具抗生素。医生们表示，NHs 中适当使用抗生素需要付出巨大努力，但与其他医疗问题相比，这并不是他们的首要任务。制定适合 NH 背景的指南、进行良好实践审计并反馈抗菌药物处方、加强多学科关系以及促进城市和医院专业人员之间的讨论被认为是潜在的干预措施。医疗协调员的角色被描述为核心。根据医生的说法，利益相关者之间的合作、在整个过程中提供支持和培训可能是确保成功实施的有效策略。
抗菌药物处方是一个复杂的决策过程，涉及 NHs 中的不同因素和参与者。量身定制的指南、良好实践审计、加强多学科合作被提出作为抗菌药物管理的关键干预措施。医生强调了医疗协调员的核心作用，同时还需要利益相关者的参与、合作、培训和持续支持，以确保成功实施。
