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J Am Med Dir Assoc. 2019 Jul 18. pii: S1525-8610(19)30442-6. doi: 10.1016/j.jamda.2019.05.016. [Epub ahead of print]

Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities.

Author information

1
Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: Catherine.Pluss@chuv.ch.
2
Community Pharmacy Center, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland.
3
Service of Hospital Preventive Medicine, Lausanne University Hospital, and Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland.
4
Pharmacie des Hôpitaux de l'Est Lémanique, Vevey, Switzerland.
5
Pharmacie des Hôpitaux du Nord Vaudois et de la Broye, Yverdon-les-Bains, Switzerland.
6
Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
7
Community Pharmacy Center, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland; Community Pharmacy Practice Research, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Lausanne, Switzerland.
8
Service of Hospital Preventive Medicine, Lausanne University Hospital, and Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland. Electronic address: Christiane.Petignat@chuv.ch.

Abstract

OBJECTIVES:

The objective of this study is to describe antibacterial use in long-term care facilities and to investigate the determinants of use.

DESIGN:

This study is a quality improvement study conducted from January 2011 to December 2016.

SETTING:

Long-term care facilities in the canton of Vaud, Western Switzerland, were investigated.

PARTICIPANTS:

Twenty-three long-term care facilities were included in this study.

INTERVENTION:

The intervention included the publication of local guidelines on empirical antibacterial therapy and the implementation of physician-pharmacist-nurse quality circles.

MEASURES:

The main outcome was antibacterial use, expressed as defined daily doses (DDD) per 1000 beds per day. Statistical analyses were performed through a 1-level mixed model for repeated measurements.

RESULTS:

Antibacterial use decreased from 45.6 to 35.5 DDD per 1000 beds per day (-22%, P < .01) over the 6-year study period, which was mostly explained by reduced fluoroquinolone use (-59%, P < .001). A decrease in range of use among LTCFs was observed during the study period, and 27% of antibacterial use was related to the WATCH group (antibiotics with higher toxicity concerns and/or resistance potential) according to the AWaRe categorization of the WHO, decreasing from 17.3 DDD per 1000 beds per day to 9.5 (-45%) over the study period. The use of antibacterials from the RESERVE group ("last-resort" treatment options) was very low.

CONCLUSION AND IMPLICATIONS:

A reduction in facility-level antibacterial use and in variability across LTCFs was observed over the study period. The dissemination of empirical antibacterial prescription guidelines and the implementation of physician-pharmacist-nurse quality circles in all LTCFs of the canton of Vaud likely contributed to this reduction. Antibacterials from the WATCH group still represented 27% of the total use, providing targets for future antibiotic stewardship activities.

KEYWORDS:

Antibacterial agents; drug utilization; long-term care facilities; surveillance

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