S7.8 Antibiotic consumption, infection prevention and antibiotic resistance in the elderly
Chair: Hanne Eriksen & Morten Lindbæk
Elderly have an increased risk of infections that means that the amount of antibiotics used in elderly is significantly higher than in most of the other age-groups (apart from young children). The treatment of these patients is being threatened by the increase in resistance to antibiotics. Antibiotic resistance (AMR) can be a natural phenomenon but factors such as over- or inappropriate use of these medicines and suboptimal infection control practices is driving an ever-faster development of AMR. A review on AMR, conclude that if actions is not taken AMR will be one of the leading causes of death by 2050, exceeding deaths due to cancer. The objectives of this symposium is to inform persons working with elderly about the challenge of AMR as well as to provide information about successful interventions in order to optimize antibiotic use and implementation of infection control measures to prevent the development and spread of AMR.
S7.7.1 Antibiotic resistance and use of antibiotics among elderly in Norway
The Norwegian Institute of Public Health, Norway
Background: Knowing the burden of antibiotic resistance (AMR) and the pattern of antibiotic consumption is a cornerstone in the work against AMR. In Norway, law regulates collection of this type of information in different health registers. Material/methods: This study is based on data on antibiotic sales data 2016 from the Norwegian Prescription Database and data from 1995 to 2016 on the incidence of antimicrobial resistance in selected organisms (Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE) and Carbapenemase-Producing Organisms (CPOs) from the Norwegian Surveillance System for Communicable Diseases (MSIS). Results: Altogether 19 040 cases of MRSA, VRE and CPOs were notified to MSIS. Of these 4 749 (25 %) were registered as occurring in people over 65. Given that about 17% of the Norwegian population is in this age group (according to Statistics Norway). Of MRSA cases about 1/3 were diagnosed in LTCFs and 1/3 in primary practice. The majority of VRE and CPOs are diagnosed in hospitals. According to the Norwegian Drug register antibiotic consumption increases with age; about 30 % of those above 70 years receive at least one antibiotic treatment annually (20 % of those below 70 year). Antibiotic prescribing practices varied between counties and health care institutions. Conclusion: Data from MSIS confirms that elderly is over represented when it comes to antibiotic consumption and AMR. Better antibiotic prescribing and infection control practices among elderly may greatly benefit society as a whole by reducing the overall development of AMR in Norway.
S7.8.3 Intervention study on promoting prudent antibiotic use in Norwegian long- term care facilities (LTFC)in the county of Østfold
University of Oslo, Norway
Background: The Norwegian action plan on antibiotic resistance aims to achieve a 30% reduction in human antibiotic consumption by 2020. A total of 7% of all antibiotic consumption in Norway is used in LTCF. Method: This study is based on antimicrobial stewardship interventions and academic detailing. A main focus is reduction of antibiotic use in urinary tract infections, which is the dominant cause of antibiotic use in LTCF. The data collected are based on antibiotic sales data from pharmacies supplying the LTCF and repeated point prevalence studies conducted throughout the intervention. Results: Of 42 LTCF in Østfold country 40 is included in this study. One year after the intervention, we found a reduction of 14% in total antibiotic use, with the largest proportion in UTI antibiotics. Conclusion: A resource-limited intervention in Østfold has demonstrated a large and significant reduction in antibiotic consumption in LTCFs.
S7.8.3 A structured training program for health workers in intravenous treatment with fluids and antibiotics in nursing homes: A modified stepped-wedge cluster-randomised trial to reduce hospital admissions
University of Oslo, Norway
Background: Hospitalization is potentially detrimental to nursing home patients and resource demanding. This study assessed if a brief training program in administrating intravenous fluids and antibiotics in nursing homes could reduce hospital transfers and ensure high quality care locally. Methods and materials: A modified cluster-randomized stepped-wedge trial with randomization on nursing home level.330 cases in 296 nursing home residents from 30 nursing homes were included. Cases were patients provided intravenous antibiotics or intravenous fluids, in nursing home or hospital. Primary outcome was localization of treatment, secondary outcomes were number of days treated, days of hospitalization, type of antibiotics used and 30-day mortality. The nursing homes sequentially received a one-day educational program for the health workers including theory and practical training in intravenous treatment of dehydration. Results: The intervention had a highly significant effect on treatment in nursing homes (OR 8.35, 2.08 to 33.6; P<0.01). The number treated in nursing homes was stable over time; the number treated in hospital gradually decreased. Mortality was insignificantlly higher in the intervention group and was associated with reduced consciousness and elevated C-reactive protein. Conclutions: A brief educational program delivered to nursing home personnel was feasible and effective in reducing acute hospital admissions from nursing homes for treatment of dehydration and infections.
S7.8.4 Interleukin-6 concentrations in the urine and dipstick analyses were related to bacteriuria but not symptoms in the elderly: a cross sectional study of 421 nursing home residents
Per Daniel Sundvall
Primary Health Care in Southern Älvsborg County, Sweden
BACKGROUND: Up to half the residents of nursing homes have asymptomatic bacteriuria (ABU), which should not be treated with antibiotics. A complementary test to discriminate between symptomatic urinary tract infections (UTI) and ABU is needed. METHODS: Voided urine specimens for culture, urine dipstick and IL-6 analyses and symptoms forms were collected from all residents capable of providing a voided urine saple, regardless of the presence of symptoms. RESULTS: Recent onset of nonspecific symptoms was common among elderly residents of nursing homes (85/421). Urine cultures were positive in 32%, Escherichia coli was the most common bacterial finding. Residents without nonspecific symptoms had positive urine cultures as often as those with nonspecific symptoms with a duration of up to one month. Residents with positive urine cultures had higher concentrations of IL-6 in the urine (p<0.001). However, among residents with positive urine cultures there were no differences in IL-6 concentrations or dipstick findings between those with or without nonspecific symptoms. CONCLUSIONS: Nonspecific symptoms among elderly residents of nursing homes are unlikely to be caused by bacteria in the urine.
S7.8.5 Infection control; important actions to meet the challenge of antibiotic resistance in primary health care
The Norwegian Institute of Public Health, Norway
Background: Infection risk increases with age, at the same time the consequences of an infection are greater. Patients are hospitalized for shorter time. This increase the pressure on primary health care for improved infection control practice. Among the elderly in nursing homes, healthcare associated infections are the direct cause of death in 23-67% of cases. The incidence of infections and colonization of antibiotic resistant microbes is also increasing. Method: A systematic literature review was performed on the effect of different elements included in standard precautions on infection /antibiotic resistance. Standard precautions is defined as the basic level of infection control precautions that are to be used, in the care of all patients e.g. hand hygiene and use of personal protective equipment. Results: Standard precautions, especially hand hygiene, is identified as the most important and cost-effective measures to prevent healthcare-associated infections and was found to be among the most cost- efficient means to prevent antibiotic resistance. Both by reducing the need for antibiotics and preventing spread of resistant microbes. Conclusion: The different standard precaution elements is among the most cost- efficient means to prevent antibiotic resistance. To prevent the development and spread of antibiotic resistance it is a need to increase the compliance and implementation of infection control measures such as optimal hand hygiene