The European Surveillance of Antimicrobial Consumption (ESAC) Survey of Parenteral Antibiotic Use in 270 European Nursing Homes in 2009

Background: Routes of administration of antibiotics (ABs) and the determinants of parenteral AB use among nursing home (NH) residents have not been studied before in Europe.

Objective: To analyze prevalence and determinants of the use of parenteral ABs among NH residents in Europe.

Methods: A point prevalence study, on AB use, characteristics of residents and features of the NH was conducted in European NHs in 2009.

Results: Results from 270 NHs in 17 European countries are available. Overall, 25,892 NH residents were included and data on 1760 AB treatments were collected. The distribution of the routes of administration was: 90% orally, 9% parenterally, and 1% nasally. The prevalence of vascular catheters was 0.7% for the overall residents and 3.6% for the AB treated ones (n=1740). Of the latter, 56% received AB parenterally. The indication for administration of parenteral ABs was: empirical (74%), documented infection (20%), and prophylactic use (6%). Compared with other administration routes, parenteral ABs contained more empirical and documented treatments (for oral and nasal, 49%, p<0.0001, and 16%, p>0.2, respectively) and less prophylactic use (34%, p<0.0001). Most parenteral ABs were indicated for empirical treatment of respiratory tract infections (51%). Also, a large part was indicated for documented and empirical treatment of urinary tract infections (14% and 8.5%, respectively). The most frequently used parenteral ABs were cephalosporins (J01D, 48%), combinations of penicillins and beta-lactamase inhibitors (J01CR, 13%), and extended-spectrum beta-lactam penicillins (J01CA, 12%). Cephalosporins were significantly more frequently administered parenterally (p<0.0001) compared to other routes of administration, while this was less for quinolones (J01M) and other antibiotics (J01X) (p=0.0002 and p<0.0001, respectively). The prevalence of parenteral AB and catheter use corresponded only to a small extent (e.g. only three countries showed both the highest parenteral AB and vascular catheter use).

Conclusions: A small, but important, part of ABs in NHs is administered parenterally, mainly for respiratory and urinary tract infections. The majority of parenteral ABs is cephalosporins. A clear indication for the use of parenteral ABs is not found within vascular catheter use or NH profiles. The effect of parenteral administration of ABs on infection risk remains to be examined.