M. MCARTHUR, B. LIU, A. E. SIMOR, J. ALLARD, E. AGHDASSI, AND A. MCGEER. Mount Sinai and The Toronto Hospitals, Sunnybrook Health Science Centre and The University of Toronto, Toronto, Ontario.

Objective: 25-75% of antibiotic use in long term care facilities (LTCFs) is reported to be inappropriate. As part of a study to determine the effect of multivitamin supplements on infection rates in residents of LTCFs we looked at the type, frequency and indications for all antibiotics ordered.

Methods: Prospective surveillance for infections and antibiotic orders was done by the facility ICP. Retrospective chart audits were done by the study nurse. A diagnosis of infection by either the study nurse or the facility ICP was accepted.

Results: 706 residents of 20 LTCFs were followed for a total of 157,688 resident days. There were 583 orders for systemic antibiotics (468 episodes) for a rate of 3.7 antibiotic courses / 1000 resident days. More than one antibiotic was ordered in 87 (19%) episodes. The most commonly used antibiotics were: ciprofloxacin (17% of all antibiotic orders), cefuroxime (16%), amoxicillin (9%), trimethoprim/sulfamethoxazole (9%), clarithromycin (8%), cephalexin (9%), and cefaclor (7%). The mean percent of infections treated with antibiotics was 76% (range of 11-100% by home). 143/ 147 (97%) of lower respiratory tract infections, 47/115 (41%) upper respiratory tract infections (URI), 69/79 (90%) skin and soft tissue infections, and 33/33 (100%) symptomatic urinary tract infections were treated. Antibiotics were ordered for prophylaxis on 32 occasions. 29% (134) of all episodes treated did not fit the definition for infection by either the facility ICP or the study ICP, 44 of these were asymptomatic bacteriuria.

Conclusion: In these homes the rates of antibiotic utilization were similar to published data. The fact that 10% of all episodes treated with antibiotics were URIs, 9% were for asymptomatic bacteriuria, and an additional 19% did not meet the definition of infection, indicates that there is potential for improvement in antibiotic utilization in LTC.

Presented at:

COMMUNITY AND HOSPITAL INFECTION CONTROL ASSOCIATION - CANADA (CHICA) conference, Moncton NB, Canada, May 31, 1999.

©Copyright 1999 Last Modified