The European Surveillance of Antimicrobial Consumption (ESAC) Point Prevalence Survey of Indications for Antibiotic Treatment in 270 European Nursing Homes in 2009

Background: In the context of the European Surveillance of Antimicrobial Consumption (ESAC) Nursing Home (NH) subproject the first European point prevalence survey on antibiotic (AB) use was conducted in April 2009.

Objective: The aim was to explore the indications for prophylactic, empirical and documented AB treatment among NH residents.

Methods: NHs in 17 European countries were asked to complete a questionnaire for each resident treated with AB. The survey included all oral, rectal, intramuscular and intravenous treatments with antimycotics and antibacterials for systemic use, including drugs for treatment of tuberculosis. AB treatment by inhalation and topical use of mupirocin for MRSA decolonization were also recorded. Four groups of indications for AB therapy could be registered: prophylactic, empirical or documented treatment and nasal decolonization of MRSA carriage. Data were obtained from nursing notes, medication administration records and staff in relation to antimicrobial prescribing, facility and resident characteristics. Descriptive analyses were performed.

Results: Among 27614 eligible residents in 270 NHs, 1740 residents were treated with one or more antimicrobials. A total of 1760 ABs were prescribed for 1682 infections. Reasons for AB treatment (n=1743) involved prophylactic, empirical and documented treatment in 31.6%, 50.7% and 16.5% of the indications, respectively. Nasal decolonization was performed in 1.1% of the AB treatments. Prophylaxis (n=547) with one or more ABs was primarily given for the prevention of urinary tract infections (UTIs; 89.6%), followed by respiratory tract infections (RTIs; 4.8%) and other infections (heterogenous group; 2.4%). Empirical treatment was mostly started for a RTI (52.8%), preceding UTIs (23.3%) and other infections (12.7%). The main indications for documented treatment (n=275) were UTIs (73.1%), prior to other infections (8.0%) and surgical wound infections (6.5%). The most frequent indications for AB use concerned the urinary tract (n=891; 53%), with prophylaxis (55%) being the main indication within this group, ranking before documented (22.6%) and empirical (22.4%) treatment. Antimicrobials from class J01X (other antimicrobials) were the primary choice of molecules for all three indications. The second most frequently reported indications were related to the respiratory tract (n=494; 29.4%). Of these, 91.9% were treated empirically, while 5.3% were managed with prophylaxis. Therapy was microbiologically-documented in only 2.8% of all RTIs. Beta-lactam penicillins (J01C) were the first choice to be used for the three indications.

Conclusions: The most frequently reported indications for AB treatment were related to the urinary tract with the majority of the treatments given prophylactically. However, the leading curative reasons for AB use were RTIs.