Catherine Plüss-Suard1, Anne Niquille2, Delphine Héquet3, Séverine Krähenbühl4, Renaud Pichon5, Giorgio Zanetti6, Olivier Bugnon7, Christiane Petignat8. 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.
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.