title: Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey.
abstract: OBJECTIVE
  In light of the emerging problem with multiresistant microorganisms in nursing homes (NHs), the European Surveillance of Antimicrobial Consumption NH subproject was set up to measure and describe antimicrobial use across Europe. The aim of this paper was to investigate the indications for antimicrobial use and hence identify targets for quality improvement.
  
  
  METHODS
  Data were obtained from a point prevalence survey conducted in 323 NHs across 21 European countries. A resident questionnaire had to be completed for each resident receiving an antimicrobial, collecting data such as compound name and indication for antimicrobial prescribing. Four main indications for antimicrobial use were recorded: nasal decolonisation of methicillin-resistant Staphylococcus aureus (MRSA) carriage with mupirocin, prophylactic, empirical, and microbiologically documented treatments. The latter three treatment types were further subdivided according to the targeted infections.
  
  
  RESULTS
  In total, 1966 residents were treated with 2046 antimicrobials. Empirical treatments were most common (54.4% of all antimicrobial therapies; prevalence: 3.39 per 100 eligible residents), followed by prophylactic (28.8%; prevalence: 1.87%) and microbiologically documented (16.1%; prevalence: 1.01%) regimes. MRSA decolonisation with nasal mupirocin (0.7%; prevalence: 0.02%) was uncommon. Antimicrobials were most frequently prescribed for the prevention or treatment of urinary (49.5%; prevalence: 3.23%) and respiratory (31.8%; prevalence: 1.81%) tract infections. A very high proportion of uroprophylaxis was reported (25.6% of all prescribed antimicrobials; prevalence: 1.67%).
  
  
  CONCLUSIONS
  The indications for antimicrobial prescribing varied markedly between countries. We identified uroprophylaxis as a possible target for quality improvement.
authors.affiliation: Healthcare Associated Infections & Antimicrobial Resistance Unit, Directorate Public Health & Surveillance, Scientific Institute of Public Health, Brussels, Belgium. katrien.latour@wiv-isp.be
authors.forename: Katrien
authors.initials: K
authors.lastname: Latour
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Catry
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Broex
authors.forename: Vanessa
authors.initials: V
authors.lastname: Vankerckhoven
authors.forename: Arno
authors.initials: A
authors.lastname: Muller
authors.forename: Rudi
authors.initials: R
authors.lastname: Stroobants
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Béatrice
authors.initials: B
authors.lastname: Jans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D005060:Europe; D005260:Female; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires
chemical_list: D000890:Anti-Infective Agents