Point prevalence study of infections and use of antibiotics in Polish long-term-care facility*

Background: Nosocomial infections are a very well-known public health problem with consequences such as medical, economical, ethical, etc. Information about epidemiology and microbiology is used as a basis for legislation of special programs for infection prevention and control in hospitals and long term facilities (LTCF). Unfortunately, it is an unknown practice in Polish LTCF. The prevalence study can be the first step for introduction of regular continuous surveillance.

Objective: The aim of this work was to analyze the epidemiology of infections and antibiotics use among residents of Zaklad Opiekunczo-Leczniczy (ZOL) in Krakow.

Methods: Point prevalence study was carried out in October 2009 in a public general nursing home with 24h/day nursing supervision with Infection Control Team on a group of 104 residents (4 wards), which comprised 25.5% of all studied ZOL residents.

Results: 61.6% of studied residents had wheelchair disability or were bedridden, 10.6% were disoriented in time and/or space. Using definitions that were based on those proposed by McGeer, 6 cases of respiratory tract infections - RTI (influenza-like illness) and 13 cases of skin infections - WI (lower leg ulcerations, decubitus ulcers) were reported. No symptomatic urinary tract infections were reported –  asymptomatic bacteriuria was not qualified as an infection. General prevalence rate was found to be 18.3% with 5.8% RTI and 12.5% WI. The most common etiological factor for all types of infections were Gram negative bacteria: 71.4% with Pseudomonas aeruginosa – 21.4%. All isolated Staphylococcus aureus (28.6% of all bacteria) strains were MRSA which in 100% were resistant to fluoroquinolones (FLU). The prevalence of antibiotic use was 5.8% (empiric therapy: 83%).

Conclusions: Several studies performed in other countries have reported a high prevalence of infections and antibiotic use in LTCF. This study showed that the prevalence of antibiotic use was three times lower then the prevalence of infections. Overuse of antibiotic was not common in analyzed ZOL, but infection prevalence rate and resistance of microorganisms showed importance of infection control.

* This study was financed by the Ministry of Science and Higher Education within the contract no. N N 404 047236