Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities

J Am Med Dir Assoc. 2020 Jan;21(1):78-83. doi: 10.1016/j.jamda.2019.05.016. Epub 2019 Jul 18.

Abstract

Objectives: The objective of this study is to describe antibacterial use in long-term care facilities and to investigate the determinants of use.

Design: This study is a quality improvement study conducted from January 2011 to December 2016.

Setting: Long-term care facilities in the canton of Vaud, Western Switzerland, were investigated.

Participants: Twenty-three long-term care facilities were included in this study.

Intervention: The intervention included the publication of local guidelines on empirical antibacterial therapy and the implementation of physician-pharmacist-nurse quality circles.

Measures: The main outcome was antibacterial use, expressed as defined daily doses (DDD) per 1000 beds per day. Statistical analyses were performed through a 1-level mixed model for repeated measurements.

Results: Antibacterial use decreased from 45.6 to 35.5 DDD per 1000 beds per day (-22%, P < .01) over the 6-year study period, which was mostly explained by reduced fluoroquinolone use (-59%, P < .001). A decrease in range of use among LTCFs was observed during the study period, and 27% of antibacterial use was related to the WATCH group (antibiotics with higher toxicity concerns and/or resistance potential) according to the AWaRe categorization of the WHO, decreasing from 17.3 DDD per 1000 beds per day to 9.5 (-45%) over the study period. The use of antibacterials from the RESERVE group ("last-resort" treatment options) was very low.

Conclusion and implications: A reduction in facility-level antibacterial use and in variability across LTCFs was observed over the study period. The dissemination of empirical antibacterial prescription guidelines and the implementation of physician-pharmacist-nurse quality circles in all LTCFs of the canton of Vaud likely contributed to this reduction. Antibacterials from the WATCH group still represented 27% of the total use, providing targets for future antibiotic stewardship activities.

Keywords: Antibacterial agents; drug utilization; long-term care facilities; surveillance.