Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK.

IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Age and ageing Pub Date : 2025-01-06 DOI:10.1093/ageing/afae288
Nicosha De Souza, Bruce Guthrie, Suzanne Grant, Fabiana Lorencatto, Jane Dickson, Aleksandra Herbec, Carmel Hughes, Jacqueline Sneddon, Peter T Donnan, Charis A Marwick
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Abstract

Background: There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance.

Objective: To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics.

Design: Population-based analyses using administrative data.

Setting and subjects: 148 care-homes in two Scottish regions, with 6633 residents registered with 139 general practices.

Methods: Prescriptions for any antibiotic and for broad-spectrum antibiotics between 1 April 2016 and 31 March 2017 were analysed using cross-classified multilevel negative binomial regression.

Results: For any antibiotics, the mean prescription rate was 6.61 (SD 3.06) per 1000 resident bed-days (RBD). In multivariate analysis, prescribing was associated with resident age [incidence rate ratio (IRR) 1.30 [95% confidence interval 1.19 to 1.41] for 90+ versus <80 years old] and comorbidity (1.88 [1.71 to 2.06] for Charlson Comorbidity Index 3+ versus 0), and the care-home's sampling rate for microbiological culture (1.53 [1.28 to 1.84] for >7 versus <3.5 samples per 1000 RBD), with residual unexplained variation between care-homes (median IRR 1.29 [1.23 to 1.36]) and general practices (1.11 [1.05 to 1.18]). For broad-spectrum antibiotics, the mean rate was 0.98 (0.92) per 1000 RBD. Broad-spectrum prescribing was also associated with resident age, sex, comorbidity and sampling rate, with larger residual unexplained variation between care-homes (1.56 [1.36 to 1.77]) and general practices (1.51 [1.31 to 1.72]).

Conclusion: Variation in prescribing was influenced by resident case-mix, but there is significant unexplained variation between care-homes and between general practices, indicating a need for antibiotic stewardship to target both.

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护理院居民的抗生素处方:一项基于人群的交叉分类多层次分析在苏格兰,英国。
背景:老年人护理之家的抗生素处方存在很大差异,这对住院治疗结果和抗菌素耐药性有影响。目的:量化抗生素处方的变化及其与住院医师、护理院和全科医生特征的关系。设计:使用管理数据进行基于人口的分析。环境和研究对象:苏格兰两个地区的148所护理院,6633名居民注册了139家全科诊所。方法:采用交叉分类多水平负二项回归分析2016年4月1日至2017年3月31日期间所有抗生素和广谱抗生素的处方。结果:所有抗生素的平均处方率为6.61 (SD 3.06) / 1000住院日(RBD)。在多变量分析中,处方与居民年龄相关[发病率比(IRR) 1.30[95%置信区间1.19至1.41],90岁以上的居民与7岁的居民。结论:处方的变化受到居民病例组合的影响,但在养老院和一般做法之间存在显著的无法解释的差异,表明需要针对两者进行抗生素管理。
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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
期刊最新文献
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