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Antibiotic consumption in French nursing homes between 2018 and 2022: A multicenter survey
Published online by Cambridge University Press: 19 February 2024
Abstract
Objectives:
Monitoring antibiotic consumption is a key component to steer antimicrobial stewardship programs, including in nursing homes. We analyzed changes in antibiotic consumption in French nursing homes during 5 years, including the COVID-19 pandemic, to identify potential priorities for improvement.
Design:
A multicenter survey was conducted between 2018 and 2022.
Setting:
The study was conducted across 220 French nursing homes with on-site pharmacies.
Method:
Antibiotic consumption data were collected from pharmacy records and are expressed as defined daily doses per 1,000 resident days. Antibiotic indicators promoted by health authorities were calculated from quantitative data to evaluate the quality of prescribing.
Results:
Antibiotic consumption significantly decreased between 2018 and 2022, particularly during the coronavirus disease 2019 (COVID-19) pandemic, despite a slight increase in 2022. During the study period, the most used antibiotic classes were penicillins (61.9% in 2022) followed by cephalosporins (10.5%), macrolides–lincosamides–streptogramins (7.3%) then fluoroquinolones (7.0%). Amoxicillin–clavulanic acid was the most consumed antibiotic; amoxicillin and ceftriaxone ranked second and third. Azithromycin consumption increased from 2020, as did the indicator regarding broad-spectrum antibiotics.
Conclusions:
The decreasing trend in antibiotic use and control of fluoroquinolone use over the study period suggest compliance with antibiotic use guidelines. However, changes in the use of broad-spectrum antibiotics and the substantial use of amoxicillin-clavulanic acid, although it is rarely a first-line antibiotic, highlight the need for antimicrobial stewardship activities and the usefulness of antibiotic consumption surveillance to identify priorities.
- Type
- Original Article
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- © The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
References
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022;399:629–655.Google Scholar
Surveillance de la résistance bactérienne aux antibiotiques en soins de ville et en Établissements Pour Personnes Âgées Dépendantes. Mission Primo: Résultats 2021. Santé Publique France. https://www.santepubliquefrance.fr/maladies-et-traumatismes/infections-associees-aux-soins-et-resistance-aux-antibiotiques/resistance-aux-antibiotiques/documents/rapport-synthese/surveillance-de-la-resistance-bacterienne-aux-antibiotiques-en-soins-de-ville-et-en-etablissements-pour-personnes-agees-dependantes.-mission-primo3. Accessed August 29, 2023.Google Scholar
Rodríguez-Villodres, Á, Martín-Gandul, C, Peñalva, G, et al. Prevalence and risk factors for multidrug-resistant organisms colonization in long-term care facilities around the world: a review. Antibiotics 2021;10:680.Google ScholarPubMed
Lim, CJ, Kong, DCM, Stuart, RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interv Aging 2014;9:165–177.Google ScholarPubMed
Enquête nationale de prévalence des infections associées aux soins et des traitements antibiotiques en Établissements d’hébergement pour personnes âgées dépendantes (Ehpad), résultats nationaux 2016. Santé Publique France website. https://www.santepubliquefrance.fr/les-actualites/2017/prev-ehpad-infections-associees-aux-soins-et-traitements-antibiotiques-en-etablissements-d-hebergement-pour-personnes-agees-dependantes-resultat. Accessed August 29, 2023.Google Scholar
National strategy for preventing infections and antibiotic resistance, 2022–2025. Ministère des solidarités et de la santé website. https://sante.gouv.fr/IMG/pdf/national_strategy_for_preventing_infections_and_antibiotic_resistance_2022-2025_.pdf. Published 2022. Accessed August 29, 2023.Google Scholar
Gouin, KA, Kabbani, S, Anttila, A, et al. Implementation of core elements of antibiotic stewardship in nursing homes—National Healthcare Safety Network, 2016–2018. Infect Control Hosp Epidemiol 2022;43:752–756.Google ScholarPubMed
Core elements of antibiotic stewardship for nursing homes. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/core-elements/nursing-homes.html. Updated 2021. Accessed August 29, 2023.Google Scholar
Marquet, A, Thibaut, S, LePabic, E, Huon, JF, Ballereau, F. Three years of antibiotic consumption evaluation in French nursing homes. Med Mal Infect 2015;45:313–317.CrossRefGoogle ScholarPubMed
Surveillance de la consommation des antibiotiques et de la résistance bactérienne dans les établissements de santé en 2022 - Méthodologie Nationale. Mission SPARES website. https://www.cpias-grand-est.fr/wp-content/uploads/2023/01/Methodologie_SPARES_2023_05-01.pdf. Accessed August 29, 2023.Google Scholar
Guidelines for ATC classification and DDD assignment, 2023. WHO Collaborating Centre for Drug Statistics Methodology website. https://www.whocc.no/atc_ddd_index_and_guidelines/guidelines/. Updated 2022. Accessed August 29, 2023.Google Scholar
Actualisation de la liste des antibiotiques critiques disponibles en France pour l’exercice libéral et en établissements de santé, 2022. Comité des référentiels de la SPILF website. https://www.infectiologie.com/fr/actualites/antibiotiques-critiques-disponibles-en-france_-n.html. Accessed August 29, 2023.Google Scholar
Asquier-Khati, A, Deschanvres, C, Chaslerie, A, Pereira, O, Boutoille, D, Birgand, G. Expert consensus on monitoring antimicrobial stewardship in French nursing homes using assessed reimbursement database indicators. JAC-Antimicrob Resist 2023;5:dlad037.Google ScholarPubMed
Consommation d’antibiotiques en secteur de ville en France, 2011–2021. Santé Publique France website. https://www.santepubliquefrance.fr/maladies-et-traumatismes/infections-associees-aux-soins-et-resistance-aux-antibiotiques/resistance-aux-antibiotiques/documents/rapport-synthese/consommation-d-antibiotiques-en-secteur-de-ville-en-france-2011-2021. Accessed August 29, 2023.Google Scholar
Bulletin de santé publique EPIBAC: surveillance des infections invasives bactériennes en 2021. Santé Publique France website. https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infections-a-pneumocoque/documents/bulletin-national/bulletin-de-sante-publique-epibac-surveillance-des-infections-invasives-bacteriennes-en-2021. Accessed August 29, 2023.Google Scholar
Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016;315:1864–1873.CrossRefGoogle ScholarPubMed
Havers, FP, Hicks, LA, Chung, JR, et al. Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons. JAMA Netw Open 2018;1:e180243.CrossRefGoogle ScholarPubMed
Harbin, NJ, Haug, JB, Romøren, M, Lindbæk, M. Oral and parenteral antibiotic use in Norwegian nursing homes: are primary care institutions becoming our new local hospitals? JAC-Antimicrob Resist 2020;2:dlaa093.CrossRefGoogle ScholarPubMed
Ricchizzi, E, Latour, K, Kärki, T, et al. Antimicrobial use in European long-term care facilities: results from the third point-prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill Bull 2018;23:1800394.Google ScholarPubMed
Först, G, de With, K, Weber, N, et al. Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study. J Antimicrob Chemother 2017;72:2931–2937.CrossRefGoogle ScholarPubMed
Guide des recommandations de prise en charge des infections aigües en EHPAD, 2018. OMEDIT Ile-de-France website. https://www.omedit-idf.fr/wp-content/uploads/2018/07/guide-antibios-V2018_VD.pdf. Accessed August 29, 2023.Google Scholar
Zito, S, Poluzzi, E, Pierantozzi, A, et al. Medication use in Italian nursing homes: preliminary results from the national monitoring system. Front Pharmacol 2023;14:1128605.CrossRefGoogle ScholarPubMed
Reissier, S, Cattoir, V. Streptogramins for the treatment of infections caused by gram-positive pathogens. Expert Rev Anti Infect Ther 2021;19:587–599.CrossRefGoogle ScholarPubMed
Raban, MZ, Gates, PJ, Gasparini, C, Westbrook, JI. Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985–2019: systematic review and meta-analysis. PloS One 2021;16:e0256501.CrossRefGoogle ScholarPubMed
Jump, RLP, Crnich, CJ, Mody, L, Bradley, SF, Nicolle, LE, Yoshikawa, TT. Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management. J Am Geriatr Soc 2018;66:789–803.CrossRefGoogle ScholarPubMed
Song, S, Wilson, BM, Bej, T, et al. Antibiotic use among residents receiving skilled nursing care in 29 US nursing homes. J Am Geriatr Soc 2021;69:399–406.CrossRefGoogle ScholarPubMed
AWaRe classification of antibiotics for evaluation and monitoring of use. WHO website. https://apps.who.int/iris/handle/10665/345555. Updated 2023. Accessed August 29, 2023.Google Scholar
Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics. European Medicines Agency website. https://www.ema.europa.eu/en/news/disabling-potentially-permanent-side-effects-lead-suspension-restrictions-quinolone-fluoroquinolone. Published 2018. Accessed August 29, 2023.Google Scholar
Systemic and inhaled fluoroquinolone antibiotics—reminder on restrictions of use. European Medicines Agency website. https://www.ema.europa.eu/en/medicines/dhpc/systemic-inhaled-fluoroquinolone-antibiotics-reminder-restrictions-use. Published 2023. Accessed August 29, 2023.Google Scholar
Renggli, L, Plüss-Suard, C, Gasser, M, Sonderegger, B, Kronenberg, A. Assessing the conversion of electronic medical record data into antibiotic stewardship indicators. J Antimicrob Chemother 2023;78:2297–2305.CrossRefGoogle ScholarPubMed
Shaw, D, Abad, R, Amin-Chowdhury, Z, et al. Trends in invasive bacterial diseases during the first 2 years of the COVID-19 pandemic: analyses of prospective surveillance data from 30 countries and territories in the IRIS Consortium. Lancet Digit Health 2023;5:e582–e593.CrossRefGoogle ScholarPubMed
Gouin, KA, Creasy, S, Beckerson, M, et al. Trends in prescribing of antibiotics and drugs investigated for coronavirus disease 2019 (COVID-19) treatment in US nursing home residents during the COVID-19 pandemic. Clin Infect Dis 2022;74:74–82.CrossRefGoogle ScholarPubMed
Haverkate, MR, Macfadden, DR, Daneman, N, et al. A time-series analysis evaluating antibiotic prescription rates in long-term care during the COVID-19 pandemic in Alberta and Ontario, Canada. Antibiotics 2022;11:1001.CrossRefGoogle ScholarPubMed
Vaz, ES, Vassiliades, SV, Giarolla, J, Polli, MC, Parise-Filho, R. Drug repositioning in the COVID-19 pandemic: fundamentals, synthetic routes, and overview of clinical studies. Eur J Clin Pharmacol 2023;79:723–751.CrossRefGoogle ScholarPubMed
Huttner, BD, Catho, G, Pano-Pardo, JR, Pulcini, C, Schouten, J. COVID-19: don’t neglect antimicrobial stewardship principles! Clin Microbiol Infect 2020;26:808–810.CrossRefGoogle ScholarPubMed
Langford, BJ, So, M, Raybardhan, S, et al. Bacterial coinfection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect 2020;26:1622–1629.CrossRefGoogle ScholarPubMed
Takito, S, Kusama, Y, Fukuda, H, Kutsuna, S. Pharmacist-supported antimicrobial stewardship in a retirement home. J Infect Chemother 2020;26(8).CrossRefGoogle Scholar
Kabbani, S, Palms, DL, Bartoces, M, et al. Potential utility of pharmacy data to measure antibiotic use in nursing homes. Infect Control Hosp Epidemiol 2019;40:819–820.CrossRefGoogle ScholarPubMed
Daneman, N, Campitelli, M, Giannakeas, V, et al. Influences on the start, selection, and duration of treatment with antibiotics in long-term care facilities. CMAJ Can Med Assoc J J Assoc Medicale Can 2017;189:E851–E860.CrossRefGoogle ScholarPubMed