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Am J Infect Control. 2019 Oct 30. pii: S0196-6553(19)30819-3. doi: 10.1016/j.ajic.2019.08.034. [Epub ahead of print]

Urinary tract infections in Australian aged care homes: Antibiotic prescribing practices and concordance to national guidelines.

Author information

1
National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
2
National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Healthcare Associated Infection Surveillance System Coordinating Centre at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia. Electronic address: noleen.noleen.bennett@mh.org.au.
3
National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
4
National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
5
National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia; Department of General Medicine and Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia.
6
National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Monash Infectious Diseases and Infection Control and Epidemiology, Monash Health, Clayton, Victoria, Australia.
7
National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Ballarat Health Services, Ballarat, Victoria, Australia.

Abstract

BACKGROUND:

Since 2015 the Aged Care National Antimicrobial Prescribing Survey has collected and reported data on antibiotic use in Australian aged care homes (ACHs) as part of the Australian Commission on Safety and Quality in Health Care's Antimicrobial Use and Resistance in Australia project. The objective of this study was to analyze this data source with regards to prescribing for urinary tract infections (UTIs) to improve the use of antibiotics.

METHODS:

This cross-sectional study analyzed the 2016 and 2017 survey data. Antibiotic prescribing for urinary tract indications was compared with national guideline recommendations.

RESULTS:

A total of 662 antibiotic prescriptions from 247 ACHs were analyzed. For all prophylactic antibiotics for UTI, 51.8% were prescribed for longer than 6 months, contrary to the guideline recommendation. Most antibiotics prescribed for treatment (71.6%) were for cystitis. Cefalexin was most frequently selected for treatment of cystitis, with 10.4% of these prescriptions being concordant with the recommendations. Prescribing additional daily doses of cefalexin occurred in 63.2% of prescriptions.

CONCLUSIONS:

Antimicrobial stewardship activities targeting UTI prophylaxis for durations longer than 6 months, and excessive daily doses of cefalexin to treat cystitis could yield significant reductions in unnecessary antibiotic consumption among Australian residents of ACHs.

KEYWORDS:

Anti-infective agents; Antibacterial agents; Cystitis; Long-term care; Nursing home

PMID:
31677924
DOI:
10.1016/j.ajic.2019.08.034

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