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

A Roux; D-L Vu; A Niquille; E Rubli Truchard; T Bizzozzero; A Tahar; T Morlan; J Colin; D Akpokavie; M Grandin; A Merkly; A Cassini; E Glampedakis; T Brahier; V Suttels; V Prendki; N Boillat-Blanco

doi:10.1016/j.jhin.2024.09.011

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

J Hosp Infect. 2024 Nov:153:90-98. doi: 10.1016/j.jhin.2024.09.011. Epub 2024 Sep 30.

Authors

A Roux¹, D-L Vu², A Niquille³, E Rubli Truchard⁴, T Bizzozzero⁵, A Tahar⁶, T Morlan⁷, J Colin⁸, D Akpokavie⁸, M Grandin⁹, A Merkly⁹, A Cassini¹⁰, E Glampedakis¹¹, T Brahier¹², V Suttels¹², V Prendki¹³, N Boillat-Blanco¹⁴

Affiliations

¹ Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Faculty of Medicine, University of Lausanne, Lausanne, Switzerland. Electronic address: [email protected].
² Communicable Disease Unit, Division of General Cantonal Physician, Geneva Directorate of Health, Geneva, Switzerland; Paediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.
³ Center for Primary Care and Public Health (Unisanté), Pharmacy, University of Lausanne, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Switzerland.
⁴ Geriatric Medicine and Geriatric Rehabilitation Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁵ Department of Internal Medicine and Geriatrics, Morges Hospital, Morges, Switzerland.
⁶ Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland; Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Switzerland.
⁷ Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Switzerland.
⁸ Internal Medicine Department, Trois-Chêne Hospital, Geneva, Switzerland.
⁹ Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹⁰ Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland; Infection Prevention and Control Unit, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹¹ Cantonal Infection Prevention and Control Unit, Cantonal Doctor Office, Public Health Department, Canton of Vaud, Lausanne, Switzerland.
¹² Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹³ Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland; Internal Medicine Department, Trois-Chêne Hospital, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
¹⁴ Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. Electronic address: [email protected].

PMID: 39357543
DOI: 10.1016/j.jhin.2024.09.011

Abstract

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.

Keywords: Antibiotic prescription; Long-term care facility; Lung ultrasound; Pneumonia; Respiratory tract infections.

Publication types

Observational Study
Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Anti-Bacterial Agents* / therapeutic use
Female
Humans
Inappropriate Prescribing / statistics & numerical data
Long-Term Care* / statistics & numerical data
Male
Prospective Studies
Respiratory Tract Infections* / diagnosis
Respiratory Tract Infections* / drug therapy
Switzerland

Substances

Anti-Bacterial Agents