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Care home residents much more likely to be prescribed antibiotics
The odds of the elderly being prescribed antibiotics are at least twice as high in care homes as they are in the community, a study has found.
Researchers discovered 74 per cent of those living in care homes were found to have been given at least one antibiotic during 2012 compared to 49 per cent in the community. Once the data was adjusted to take account of influencing factors on people living in care homes, such as increased frailty, age, and co-morbidities, it revealed a 2.05 times increase in antibiotic prescription. This could increase the risk of antimicrobial resistance in the care home setting, the study’s authors said.
The study was carried out by researchers in Northern Ireland in conjunction with the Public Health Agency and Queen’s University Belfast, between January 1, 2012 and December 31, 2013. Researchers reviewed available medical data for over 265,000 residents in Northern Ireland aged 65 and over.
Dr Lynsey Patterson, one of the authors, said: “The development of antibiotics in the last century revolutionised medicine and enabled us to treat serious infections. However, we now use more antibiotics than we need to. This makes bacteria resistant and antibiotics less and less effective at treating the serious bacterial infections they are needed for.
“If we continue to use antibiotics at the current rate, we could face a return to the days before antibiotics, when people died from minor infections and where the risk of infection made routine surgery life threatening. For this reason, antibiotic resistance is a threat to everyone’s health.”
The researchers found that the number of people prescribed an antibiotic increased in the month preceding and the month following entrance to a care home. The data showed that 15.5 per cent of those included in the study had been prescribed antibiotics in the five months before going to a care home. Six months after admission, that percentage had increased to 23.3 per cent – a proportionate increase of 51.5 per cent.
In the paper, which has been published in the journal of Epidemiology and Infection, the authors acknowledged that the frailty of those living in care homes went some way in explaining the higher prescription of antibiotics there, but they were not convinced by that factor alone.
Dr Patterson said: “Care homes are very complex environments which cater for residents often with complex needs. One reason that prescribing may increase is therefore because there is a need - that is, the residents are more prone to infection than their counterparts who remain in the community.
“An alternative reason may be that some of the prescribing is inappropriate and there is evidence of this from other studies. We were unable to explore this in our study because we did not have access to the reason why the antibiotic was prescribed, but this does warrant further investigation.”
Prescription methods differ between community and care home settings. Older people living in the community will typically be assessed by a GP in a face–to-face consultation, before a decision is made about an antibiotic.
In the care home setting, a healthcare professional often makes contact with the GP on behalf of the resident. Clinical information, such as temperature, symptoms, or results for a urine dipstick test, may be gathered by GP admin staff.
A GP in the practice will then make a decision on whether to make a home visit, contact the care home for more information, or issue a prescription without further contact.
An independent review on Antimicrobial Resistance predicts that if trends in antimicrobial resistance continue, then by 2050, 10 million lives will be lost to it each year.
“Antimicrobial resistance is dangerous because our current suite of antibiotics is becoming less effective at treating serious bacterial infections,” Dr Patterson said.“This, combined with a lack of development of new antibiotics, means that we are effectively running out of options for treating serious bacterial infections. This is why an independent review of AMR cited that mortality from AMR will potentially exceed current deaths from cancer by 2050.”
Notes to editors:
Paper details: Evidence of a care home effect on antibiotic prescribing for those that transition into a care home: a national data linkage study. Epidemiology and Infection. DOI: 10.1017/S0950268818003382
About the author: At the time of this study Dr Lynsey Patterson was a Field Epidemiology Training Programme Fellow with an interest in healthcare associated infections and anti-microbial resistance. She is now a Senior Epidemiological Scientist at the PHA and has an honorary research fellow position at the Centre for Public Health, Queen’s University Belfast. Her research interests are infectious diseases and pharmaco-epidemiology.
About the journal of Epidemiology and Infection: Epidemiology and Infection is a fully open access journal published by Cambridge University Press. It publishes original reports and reviews on all aspects of infection in humans and animals. Particular emphasis is given to the epidemiology, prevention and control of infectious diseases. The field covered is broad and includes the zoonoses, tropical infections, food hygiene, vaccine studies, statistics and the clinical, social and public-health aspects of infectious disease. Papers covering microbiology and immunology which have an epidemiological relevance are part of this broad field. Papers come from medical and veterinary scientists worldwide. It has become the key periodical in which to find the latest reports on recently discovered infections and new technology. For those concerned with policy and planning for the control of infections, the papers on mathematical modelling of epidemics caused by historical, current and emergent infections, will be of particular value.
About Cambridge University Press: Cambridge University Press is part of the University of Cambridge. It furthers the University's mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. Its extensive peer-reviewed publishing lists comprise 50,000 titles covering academic research and professional development, as well as school-level education and English language teaching. Playing a leading role in today's international marketplace, Cambridge University Press has more than 50 offices around the globe, and it distributes its products to nearly every country in the world.