Factors associated with antibiotics for respiratory infections in Swiss long-term care facilities

Article Article scientifique Article Factors associated with antibiotics for respiratory infections in Swiss long-term care facilities eng 2024-09-30 author Roux Alexia author Vu Cantero Diem-Lan 527382 author Niquille Anne 0000-0001-8643-5731 630204 author Truchard Eve Rubli author Bizzozzero Tosca author Tahar Chaouche Aurélie 877143 author Morlan Thibaud 928837 author Colin Julien 749159 author Akpokavie Dela 801118 author Grandin Margaux 906795 author Merkly Axel Matthias Sebastian 896234 author Cassini Alessandro author Glampedakis Emmanouil author Brahier Thomas author Suttels Véronique author Prendki Virginie 0000-0003-1315-2938 811987 dept de réadaptation et gériatrie (MIGRG) author Boillat-Blanco Noémie 10.1016/j.jhin.2024.09.011 39357543 0195-6701 https://linkinghub.elsevier.com/retrieve/pii/S0195670124003189 Background: Long-term care facility (LTCF) residents are twice as likely to receive antibiotics compared with elderly living in the community, and studies have reported up to half of prescriptions in LTCFs as inappropriate. Aim: To identify factors contributing to general and inappropriate antibiotic prescription among LTCF residents with lower respiratory tract infections (LRTIs). Methods: In this prospective, multicentric, observational study, residents with LRTIs were recruited among 32 LTCFs in Western Switzerland during winter 2022-2023. Residents underwent lung ultrasound (LUS) within three days of LRTI onset, serving as the pneumonia diagnosis reference standard. Multivariate logistic regression and backward selection were used with P < 0.1 cut-off to identify factors among demographics, vital signs, diagnostic tests, and LTCF characteristics associated with (i) antibiotic prescription and (ii) inappropriate prescription. Findings: A total of 114 residents were included, 63% female, median age 87 years. Fifty-nine (52%) residents underwent diagnostic tests: 50 (44%) polymerase chain reaction (PCR) for respiratory viruses and 16 (14%) blood test with C-reactive protein and/or blood count. Sixty-three (55%) residents received antibiotics. Factors associated with antibiotic prescriptions were Rockwood Clinical Frailty Scale score ≥7, oxygen saturation <92%, performing a blood test, rural LTCFs, and female physician. Among residents receiving antibiotics, 48 (74%) had inappropriate prescriptions, with performance of respiratory virus PCR test as the only protective factor. Conclusion: Whereas half of LRTI residents received antibiotics, falling within lower ranges of European LTCFs prescription rates (53-80%), most antibiotic prescriptions were inappropriate. Utilization of diagnostic tests correlates with lower overall and inappropriate prescription, advocating for their use to optimize prescription practices in LTCFs. Antibiotic prescription Long-term care facility Lung ultrasound Pneumonia Respiratory tract infections Dewey 613 Dewey 615 Dewey 616 Dewey 618 Dewey 618.97 56 Département de médecine 221 58 Département de pédiatrie, gynécologie et obstétrique 223 31 Section des sciences pharmaceutiques 17 65 Département de réadaptation et gériatrie 22B 201 Centre de médecine de premier recours 22A9 false 235 Perception du Quorum et gènes de virulence 301 526 Résistance aux antibiotiques 866 400 Virologie clinique 668 1255 Virus émergents 993 888 Pharmacie communautaire 1440 Infections de la personne âgée 1062 The Journal of hospital infection 34622029-a95a-43af-b71c-79ed087ad6f6 Article (Published version) Public 1-s2.0-S0195670124003189-main1.pdf 705699 application/pdf CC BY-4.0 d8b664e6469443bb6a809351ad0a56ed9c8d4cf858d85a63401784b5a6d5663a openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté des sciences / Section des sciences pharmaceutiques Faculté de médecine / Section de médecine clinique / Département de réadaptation et gériatrie Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Centre de médecine de premier recours

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Factors associated with antibiotics for respiratory infections in Swiss long-term care facilities	The Journal of hospital infection			2024	92	220

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