M. LOEB, A. MCGEER, L. LANDRY, M. MCARTHUR, J. DUFFY, D. KWAN, A. E. SIMOR., Hamilton Health Sciences Corporation and McMaster University., Hamilton, Ontario, Canada; Mount Sinai Hospital, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.

INTRODUCTION: Antibiotics are among the most frequently prescribed drugs in long-term care facilities (LTCFs). The incidence and variability of antibiotic use in Ontario is unknown. Data on antibiotic use in LTCFs may help 1) optimize treatment of bacterial infections; 2) help to minimize the risk of side effects; 3) reduce the potential for the development of antibiotic resistance. Before the appropriateness of antibiotic prescription can be ascertained, the proportion of indications for antibiotic prescriptions which meet standardized criteria for infection needs to be determined.

OBJECTIVES: 1) To determine the incidence and describe the variability of antibiotic utilization in facilities providing chronic care in southern Ontario; 2) To determine how often surveillance definitions for infection are met when antibiotics are prescribed.

METHODS: Twenty-three facilities that provide chronic care were enrolled. Demographic information about the facilities was recorded. Data was collected prospectively by the facilities’ infection control practitioners who kept a line listing over an 8 month period. Information recorded included that about the antibiotic (name, dose, duration, route), the indication (infection type), and reason (new or additional antibiotic course). Antibiotic courses were randomly sampled and clinical/outcome data obtained.

RESULTS: A total of 6,127 courses of antibiotics were prescribed over the eight months. The median incidence of antibiotic use was 7.1 courses per 1000 resident days (range 2.8 - 12.8 courses per 1000 patient days. Antibiotics were prescribed for 8.1% of all patient days (range 0.6% - 14.4%). The most frequently prescribed antibiotics were trimethoprim-sulfa (16.3% of courses) and ciprofloxacin (16.1% of courses). Seventy one percent of antibiotics were prescribed for an acute episode, 21.1% as an addition or change, and 6.0% for prophylaxis. The most common indications for antibiotics were respiratory tract infections (38% of courses), urinary tract infections (32% of courses), and skin infections (12%). Seventy-one percent of randomly selected prescriptions were written after the patient was assessed by a physician while 27.2% were prescribed by telephone. Fifty-three percent of antibiotics prescribed for respiratory tract infections, 27.6% of those prescribed for urinary tract infections, and 62.2% of those prescribed for skin infections met standard definitions for surveillance. Adverse effects of antibiotics occurred in 4.5% of courses.

CONCLUSIONS: The incidence of antibiotic use in chronic care facilities is common and is highly variable. The majority of indications for antibiotic prescription do not meet standardized surveillance definitions of infection for long-term care.

Presented at:

38^th INTERSCIENCE CONFERENCE ON ANTIMICROBIAL AGENTS AND CHEMOTHERAPY. San Diego, CA, September 24-27, 1998

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