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Parenteral versus Oral Administration of Systemic Antimicrobials in European Nursing Homes

A Point-Prevalence Survey

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Abstract

Background: Residents in long-term care facilities are predisposed to healthcare-associated infections that are likely caused by antimicrobial-resistant microorganisms. Long-term care facilities are increasingly able to offer parenteral antimicrobial treatment but there are few data on the use and appropriateness of such treatment in this setting. Information on the use of parenteral antimicrobials and associated factors in long-term care facilities is necessary to assess the risks and benefits of this treatment and to support the development of antimicrobial policies aimed at minimizing the emergence and spread of antimicrobial resistance.

Objective: The aim of this study was to describe the extent of parenteral and oral antimicrobial use in participating European nursing homes (NHs) and to analyse the resident characteristics and determinants associated with route of antimicrobial administration.

Methods: Data on resident characteristics and antimicrobials were collected by means of a point-prevalence survey. Logistic regression was used to analyse the data.

Results: Based on data from 21 European countries for 2046 antimicrobial prescriptions, an average of 9.0% (range by country: 0.0–66.7%) of treatment was administered parenterally. Multivariate analysis showed that residents receiving parenteral antimicrobials had greater morbidity, such as increased risk of having a urinary catheter (p < 0.001), a vascular catheter (p < 0.001), impaired mobility (p = 0.007) and disorientation (p = 0.005). Residents receiving parenteral antimicrobials also had been admitted more recently into the NH (p = 0.007). Empirical treatment of respiratory tract infections (RTIs) accounted for the majority of parenteral antimicrobials, while prophylaxis of urinary tract infection (UTI) was the most common indication for oral antimicrobials. Beta-lactam antibacterials (cephalosporins and aminopenicillins) were the predominant classes used.

Conclusions: Our study showed that risk and care-load factors (i.e. the presence of a urinary or vascular catheter, impaired mobility, disorientation and relatively short length of stay) were associated with parenteral administration of antimicrobials in NHs. Furthermore, both the indication and the class of antimicrobial agent used were associated with administration route. For empirical treatment of RTIs, antimicrobials were most often administered parenterally.

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Acknowledgements

We thank the ESAC management team at the University of Antwerp for supporting our research on antimicrobial consumption in NHs. We would also like to thank the members of the ESAC-NH network: Karolina Böröcz (Hungary), Ana Budimir (Croatia), Robert Cunney (Ireland), Peter Davey (Scotland), Uga Dumpis (Latvia), Greta Fabbri (Italy), Margreet Filius (the Netherlands), Elizabeth Fleet (England), Gaëtan Gavazzi (France), Waleria Hryniewicz (Poland), Carmel Hughes (Northern Ireland), Ainars Judeiks (Latvia), Lars Kärvestedt (Sweden), Tatjana Lejko Zupanc (Slovenia), Maria Luisa Moro (Italy), Outi Lyytikaïnen (Finland), Beata Mazińska (Poland), Pamela McClean (Northern Ireland), Hanne Merete Eriksen (Norway), Donna Mitchell (Ireland), Abigail Mullings (Scotland), Gopal Rao (England), Svetlana Ratchina (Russian Federation), Kamil Rudolf (Czech Republic), Maija Rummukainen (Finland), Hege Salvesen Blix (Norway), Christian Stab Jensen (Denmark), Arjana Tambic (Croatia), Gábor Ternák (Hungary), Rolanda Valinteliene (Lithuania), Marie-José Veldman-Ariesen (the Netherlands), Jiri Vlcek (Czech Republic), Nicoletta Wischnewski (Germany) and Peter Zarb (Malta).

We would not have been able to perform our study without the input of the national representatives and the participating facilities in the countries.

This study was supported by a grant from the European Centre for Disease Prevention and Control (ESAC III project 2007–10, Grant Agreement GRANT/2007/001; www.esac.ac.ua.be).

None of the authors have any conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Healthcare Associated Infections and Antimicrobial Resistance, Scientific Institute of Public Health, Brussels, Belgium

    Elisabeth Broex, Boudewijn Catry, Katrien Latour, Karl Mertens & Béatrice Jans MSc

  2. Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium

    Vanessa Vankerckhoven, Arno Muller, Rudi Stroobants, Peter Zarb & Herman Goossens

Authors
  1. Elisabeth Broex
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  2. Boudewijn Catry
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  3. Katrien Latour
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  4. Karl Mertens
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  5. Vanessa Vankerckhoven
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  6. Arno Muller
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  7. Rudi Stroobants
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  8. Peter Zarb
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  9. Herman Goossens
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  10. Béatrice Jans MSc
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Correspondence to Béatrice Jans MSc.

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Broex, E., Catry, B., Latour, K. et al. Parenteral versus Oral Administration of Systemic Antimicrobials in European Nursing Homes. Drugs Aging 28, 809–818 (2011). https://doi.org/10.2165/11595350-000000000-00000

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  • DOI: https://doi.org/10.2165/11595350-000000000-00000

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