A Point Prevalence Study of Antimicrobial Use and Practice Among Nursing Homes in Singapore
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Inappropriate antimicrobial use is a major cause for the development of antimicrobial resistance in nursing homes (NHs); however, little is known about antimicrobial use at NHs in Singapore compared with NHs in other countries.
The aim of this study was to determine the prevalence, practice and challenges of antimicrobial prescribing in Singapore NHs compared with those in other countries.
A point prevalence survey (PPS) was conducted from August to October 2017. Data on antimicrobial use and the quality of documentation were retrieved from medical and/or medication records of NH residents. Informed consent was obtained from the NH management.
Nine of 73 NHs in Singapore, with a total of 1760 residents, participated in the PPS. The prevalence of oral antibiotic and topical antimicrobial use was 2% and 11%, respectively, and the worldwide point prevalence of antimicrobial prescribing in NHs ranged from 1–17% (median 8%). The key challenges identified locally were different from those of overseas NHs, including incomplete documentation of antimicrobial duration and indication of use, as well as the high prevalence of topical antimicrobial use.
The prevalence of oral antibiotic use in NHs in Singapore was lower, while topical antimicrobial use was higher, compared with NHs in other countries. Variability in antimicrobial prescribing and challenges in practice among local and overseas NHs implied that a comprehensive PPS could be beneficial to aid in the design of effective and practicable antimicrobial stewardship strategies appropriate for the NH.
The authors thank the NH pharmacists and managers who participated in this study.
Compliance with Ethical Standards
Conflict of interest
Aysu Selcuk, Kai Zhen Yap, Chee Liang Wong, Jing Xi Yang, Pei Chean Yong, Sui Yung Chan, and Christine B. Teng have no conflicts of interest relevant to the content of this article.
The management of participating nursing homes provided written informed consent. The Institutional Review Board of the National University of Singapore approved the protocol of the study.
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