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Skin and soft tissue infections and current antimicrobial prescribing practices in Australian aged care residents

  • N. J. Bennett (a1) (a2), N. Imam (a2), R. J. Ingram (a1), R. S. James (a1), K. L. Buising (a1), A. L. Bull (a2), C. S. Chen (a1), K. A. Thursky (a1) and L. J. Worth (a2) (a3)...

Abstract

To determine the burden of skin and soft tissue infections (SSTI), the nature of antimicrobial prescribing and factors contributing to inappropriate prescribing for SSTIs in Australian aged care facilities, SSTI and antimicrobial prescribing data were collected via a standardised national survey. The proportion of residents prescribed ⩾1 antimicrobial for presumed SSTI and the proportion whose infections met McGeer et al. surveillance definitions were determined. Antimicrobial choice was compared to national prescribing guidelines and prescription duration analysed using a negative binomial mixed-effects regression model. Of 12 319 surveyed residents, 452 (3.7%) were prescribed an antimicrobial for a SSTI and 29% of these residents had confirmed infection. Topical clotrimazole was most frequently prescribed, often for unspecified indications. Where an indication was documented, antimicrobial choice was generally aligned with recommendations. Duration of prescribing (in days) was associated with use of an agent for prophylaxis (rate ratio (RR) 1.63, 95% confidence interval (CI) 1.08–2.52), PRN orders (RR 2.10, 95% CI 1.42–3.11) and prescription of a topical agent (RR 1.47, 95% CI 1.08–2.02), while documentation of a review or stop date was associated with reduced duration of prescribing (RR 0.33, 95% CI 0.25–0.43). Antimicrobial prescribing for SSTI is frequent in aged care facilities in Australia. Methods to enhance appropriate prescribing, including clinician documentation, are required.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: N. J. Bennett, E-mail: Noleen.Bennett@mh.org.au

References

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1.Commonwealth of Australia (2017) 2016–17 Report on the Operation of the Aged Care Act 1997. Commonwealth of Australia Canberra.
2.Garibaldi, RA. Residential care and the elderly: the burden of infection. Journal of Hospital Infection 43(suppl), S918.
3.Kish, TD, Chang, MH and Fung, HB (2010) Treatment of skin and soft tissue infections in the elderly: a review. American Journal of Geriatric Pharmacotherapy 8, 485513.
4.Reddy, M (2008) Skin and wound care: important considerations in the older adult. Advances in Skin and Wound Care 21, 424436.
5.Gibbons, JA, et al. (2017) Antimicrobial stewardship in the treatment of skin and soft tissue infections. American Journal Of Infection Control 45, 12031207.
6.Koch, AM, et al. (2009) Severe consequences of healthcare-associated infections among residents of nursing homes: a cohort study. Journal of Hospital Infection 71, 269274.
7.Bennett, N, et al. (2018) Prevalence of infections and antimicrobial prescribing in Australian aged care facilities: evaluation of modifiable and nonmodifiable determinants. American Journal Of Infection Control 46, 11481153.
8.Stone, ND, et al. (2012) Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infection Control And Hospital Epidemiology 33, 965977.
9.Antibiotic Expert Group (2014) Therapeutic Guidelines: Antibiotic. Version 15. Melbourne Therapeutic Guidelines Limited.
10.Dermatology Expert Group (2015) Therapeutic Guidelines: Dermatology. Version 4. Melbourne Therapeutic Guidelines Limited.
11.Fagan, M, et al. (2012) Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: compliance with national guidelines. Scandinavian Journal of Primary Health Care 30, 1015.
12.European Centre for Disease Prevention and Control (2014) Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities. April-May 2013. Stockholm: ECDC.
13.Humphreys, H and Smyth, ET (2006) Prevalence surveys of healthcare-associated infections: what do they tell us, if anything? Clinical Microbiology and infection 12, 24.

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Skin and soft tissue infections and current antimicrobial prescribing practices in Australian aged care residents

  • N. J. Bennett (a1) (a2), N. Imam (a2), R. J. Ingram (a1), R. S. James (a1), K. L. Buising (a1), A. L. Bull (a2), C. S. Chen (a1), K. A. Thursky (a1) and L. J. Worth (a2) (a3)...

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