David Gillespie1, Kerenza Hood1, Antony Bayer2, Ben Carter3, Donna Duncan4, Aude Espinasse1, Meirion Evans3, Jacqueline Nuttall1, Helen Stanton5, Arun Acharjya6, Stephen Allen7, David Cohen8, Sam Groves8, Nick Francis3, Robin Howe9, Antony Johansen10, Efi Mantzourani11, Emma Thomas-Jones1, Alun Toghill1, Fiona Wood3, Neil Wigglesworth12, Mandy Wootton13, Christopher C Butler14. 1. South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK. 2. School of Medicine, Cardiff University, Cardiff, UK. 3. Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK. 4. Nutrition and Dietetics, Abertawe Bro Morgannwg Health Board, Port Talbot, UK. 5. Cardiff University, Cardiff, UK. 6. Virus Reference Department, Public Health England, London, UK. 7. College of Medicine, Swansea University, Swansea, UK. 8. Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK. 9. Microbiology Unit, Public Health Wales, Cardiff, UK. 10. Cardiff and Vale University Health Board, Cardiff, UK. 11. School of Pharmacy, Cardiff University, Cardiff, UK. 12. Welsh Healthcare Associated Infection Programme, Public Health Wales, Cardiff, UK. 13. Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, Cardiff, UK. 14. Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: the risk factors for and frequency of antibiotic prescription and antibiotic-associated diarrhoea (AAD) among care home residents are unknown. AIM: to prospectively study frequency and risks for antibiotic prescribing and AAD for care home residents. DESIGN AND SETTING: a 12-month prospective cohort study in care homes across South Wales. METHOD: antibiotic prescriptions and the development of AAD were recorded on case report forms. We defined AAD as three or more loose stools in a 24-h period occurring within 8 weeks of exposure to an antibiotic. RESULTS: we recruited 279 residents from 10 care homes. The incidence of antibiotic prescriptions was 2.16 prescriptions per resident year (95% CI: 1.90-2.46). Antibiotics were less likely to be prescribed to residents from dual-registered homes (OR compared with nursing homes: 0.38, 95% CI: 0.18-0.79). For those who were prescribed antibiotics, the incidence of AAD was 0.57 episodes per resident year (95% CI: 0.41-0.81 episodes). AAD was more likely in residents who were prescribed co-amoxiclav (hazards ratio, HR = 2.08, 95% confidence interval, CI: 1.18-3.66) or routinely used incontinence pads (HR = 2.54, 95% CI: 1.26-5.13) and less likely in residents from residential homes (HR compared with nursing homes: 0.14, 95% CI: 0.06-0.32). CONCLUSION: residents of care homes, particularly of nursing homes, are frequently prescribed antibiotics and often experience diarrhoea following such prescriptions. Co-amoxiclav is associated with greater risk of AAD.
BACKGROUND: the risk factors for and frequency of antibiotic prescription and antibiotic-associated diarrhoea (AAD) among care home residents are unknown. AIM: to prospectively study frequency and risks for antibiotic prescribing and AAD for care home residents. DESIGN AND SETTING: a 12-month prospective cohort study in care homes across South Wales. METHOD: antibiotic prescriptions and the development of AAD were recorded on case report forms. We defined AAD as three or more loose stools in a 24-h period occurring within 8 weeks of exposure to an antibiotic. RESULTS: we recruited 279 residents from 10 care homes. The incidence of antibiotic prescriptions was 2.16 prescriptions per resident year (95% CI: 1.90-2.46). Antibiotics were less likely to be prescribed to residents from dual-registered homes (OR compared with nursing homes: 0.38, 95% CI: 0.18-0.79). For those who were prescribed antibiotics, the incidence of AAD was 0.57 episodes per resident year (95% CI: 0.41-0.81 episodes). AAD was more likely in residents who were prescribed co-amoxiclav (hazards ratio, HR = 2.08, 95% confidence interval, CI: 1.18-3.66) or routinely used incontinence pads (HR = 2.54, 95% CI: 1.26-5.13) and less likely in residents from residential homes (HR compared with nursing homes: 0.14, 95% CI: 0.06-0.32). CONCLUSION: residents of care homes, particularly of nursing homes, are frequently prescribed antibiotics and often experience diarrhoea following such prescriptions. Co-amoxiclav is associated with greater risk of AAD.
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