Antimicrobial prescribing and stewardship in an ageing population
Abstract
Background: Antimicrobial resistance (AMR) is a global public health priority. This is primarily due to the rapid increase in AMR bacteria causing common healthcare-associated infections (HAI) and community-acquired infections (e.g. urinary tract infections and pneumonia). Inappropriate antimicrobial use (AMU) is an important cause of AMR. Of particular concern is AMR in long-term care facilities (LTCF), where 40-75% inappropriate prescribing occurs, leading to increased levels of multidrug resistanct (MDR) bacteria. Inappropriate AMU in LTCF includes prophylactic and broad-spectrum antimicrobial prescribing, which are contrary to local prescribing guidelines. Adverse drug events (ADEs), such as HAI as well as gastrointestinal, skin-related and neurological events, are often associated with antimicrobial use. Prevention and control of ADEs relating to antimicrobials are central to patient safety, which can be achieved through improved prescribing. Antimicrobial stewardship (AMS) represents an effective intervention for improving AMU, reducing ADEs and slowing the emergence and spread of resistant bacteria. This thesis aims to analyse antimicrobial prescribing in order to improve antimicrobial use and promote AMS in the LTCF in Ireland. In Ireland, point prevalence surveys (PPS) on HAI in LTCF (HALT) have been completed on four occasions since 2010, the most recent in 2016. However, in-depth understanding of the risk factors for HAI in LTCF remains limited due to lack of…
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