Are frequent catheter use and presence of wounds related to higher antimicrobial prescription frequencies in nursing home populations? Data from the first point prevalence survey on antibiotic use in European nursing homes in 2009

Background: Antimicrobial resistance is a major threat in Nursing Homes (NH) world-wide. Rational antibiotic (AB) prescribing is an important measure to control the emergence of AB resistance, particularly in frail NH-populations. In April 2009, the European Surveillance of Antimicrobial Consumption (ESAC) NH sub-project (University of Antwerp & Scientific Institute of Public Health, Belgium), funded by the European Centre for Disease Prevention and Control, conducted the first European Point Prevalence Survey (PPS) on AB-prescriptions in NHs in Europe (EU).

Objective: The project aimed to study the prevalence of AB-use among NH-residents and to describe risk factors and determinants at resident- and NH-level.

Methods: A European NH network, including 301 NHs in 19 countries (min. 5 NHs/country) was set up. During one single day in April 2009, NHs were invited to survey AB-use among all residents. Aggregated data for 3 risk factors (presence of urinary catheter, vascular device, wounds) were collected for the total NH-population. Following ethical approval (as per national requirements) and recruitment of NHs and residents, data were obtained from nursing notes, medication administration records and staff in relation to antimicrobial prescribing, facility and resident characteristics. Data were submitted by optical reading forms or by a customised web-based software tool. Analysis was performed on a data subset of 5 afterwards randomly selected participating NHs, to avoid selection bias due to an unequal number of participants per country.

Results: Results include data from 16 countries and 80 NHs. The mean NH size was 121 beds (range, 26 - 606 beds). On the PPS-day, a median of 5.2% (range 0 – 28.3%) of all 9201 eligible residents received an AB. In 7 NHs, no ABs were used. In the total NH-population, the median urinary catheter use was 3.5% (range 0% - 56.6%) and the prevalence of wounds reached 7.6% (range 0% - 60%). Important urinary catheter use in the NH (>3.5%) was related to a higher prevalence of AB-use (8%), compared to NHs with low catheter use (5.6%): OR (95%CI): 2.85 [1.13-7.16], p=0.025. Also higher prevalence rates of wounds (>7.6%) were strongly related to more important AB-use (8% versus 5.6%); OR: 3.57 [1.40-9.08], p=0.008. Vascular catheter use was not frequent (mean 0.5%) but important differences between NHs were observed (range 0% - 6.3%) and were not related to significantly higher AB-use.

Conclusions: Infection prevention policies for NHs should focus on prudent/rational use of urinary catheters since they are related to higher AB-use. Wound prevention and "good wound care practice" could lower the burden of health care related infections in NHs.