The European Surveillance of Antimicrobial Consumption (ESAC) Point Prevalence Survey of Antimicrobial Usage in 261 European Nursing Homes

Background:

Nursing homes are unique in that they provide both medical care and a place of residence. In general, older people suffer from an increased incidence and severity of infectious diseases due to an age-related decline in immunological function and as a consequence, receive more antimicrobial treatment.
Objective:

The purpose of this study is to investigate antimicrobial use in nursing homes for older people in Europe.
Methods:

This project is being carried out in 17 European countries and 2 administrations in the United Kingdom (UK) under the protocols of the ESAC group. The research consists of 2 point prevalence surveys (PPS) in nursing homes, the first of which took place in April 2009 and the second which is currently underway (November 2009). Following ethical approval (as per national requirements) and recruitment of nursing homes and residents, data were obtained from nursing notes, medication administration records and staff in relation to antimicrobial prescribing, facility and resident characteristics. Data were entered into customised web-based software and analysed descriptively.
Results:

We present the first results for the April PPS from 15 countries and 1 UK administration. In 261 nursing homes, 1685 residents were taking 1757 antimicrobials. The World Health Organisation's Anatomical Therapeutic Chemical Classification group J01 i.e.antimicrobials for systemic use, accounted for 95.0% of the total antimicrobials consumed (Figure 1), of which 28.9% were J01X antimicrobials e.g. nitrofurantoin, methenamine, nifurtoinol etc. and 27.5% were J01C antimicrobials i.e. penicillins. Co-amoxiclav (J01C group) was most frequently prescribed in the participating nursing homes and represented 13.8% of all antimicrobials. This was followed by nitrofurantoin (11.6%), amoxicillin (10.3%), methenamine (8.9%), ciprofloxacin (7.7%) and trimethoprim (7.4%). Although the rate of methenamine use was high (8.9%), it was prescribed for nursing home residents in only 5 countries. In one country's nursing homes, J01X accounted for almost 60% of the total prescribed antimicrobials, while in 2 countries no residents were taking antimicrobials from this group.

Conclusions:

To our knowledge this is the first study to have investigated antimicrobial use in nursing homes on a European scale. Previous ESAC research in hospitals and ambulatory care have demonstrated great variations in antimicrobial consumption between countries and this also seems to be the case in nursing homes. Widespread use of the broad-spectrum antimicrobial co-amoxiclav in European nursing homes corresponds with findings in the community. As the European population continues to age, concerted efforts are needed to minimise the risk of infection in nursing homes and to ensure more appropriate antimicrobial usage.