title: Antimicrobial prescribing in nursing homes in Finland: results of three point prevalence surveys.
abstract: OBJECTIVE
  The purpose of this study was to analyse the Finnish European Surveillance of Antimicrobial Consumption (ESAC) nursing home (NH) point prevalence surveys' (PPSs) data in detail, i.e. to evaluate the variability in the prevalence of antimicrobial prescription between NHs and its relationship to resident characteristics.
  
  
  METHODS
  All residents present in NHs for ≥ 24 h and receiving systemic antimicrobials on the day of the survey were included. Data on antimicrobials and their indications (prophylaxis or treatment, type of infection) were collected.
  
  
  RESULTS
  Three PPSs were performed: eight NHs participated in April and November 2009 and nine in May-September 2010. In total, there were 5,691 eligible residents (range by survey, 1,706-2,320; range by NH, 60-688), 716 (12.6 %; range by NH, 3.2-33.3 %) of which received at least one antimicrobial and 40 residents received two. The most common indication was prophylaxis (487/5,691, 8.6 %), mainly for urinary tract infection (UTI) (460/487, 94.5 %). Of the residents, 269/5,691 (4.7 %, range by NH, 1.5-6.0 %) were on antimicrobial treatment. UTI (119/269; 44.2 %) was the most common indication for treatment. Methenamine (306/756, 40.5 %) was the most commonly used antimicrobial, followed by trimethoprim (13.6 %) and pivmecillinam (11.0 %). In the eight NHs participating in all three surveys, the prevalence of residents receiving antimicrobials decreased from 16.6 to 9.7 %.
  
  
  CONCLUSIONS
  Antimicrobial use was common in NHs in Finland and most were used for UTI prophylaxis and treatment. The usage, however, varied among NHs and tended to decrease during the surveys. NHs may benefit from antimicrobial stewardship interventions focused on UTI.
authors.affiliation: Central Finland Health Care District, Keskussairaalantie 19, 40620, Jyväskylä, Finland. maija-liisa.rummukainen@ksshp.fi
authors.forename: M-L
authors.initials: ML
authors.lastname: Rummukainen
authors.forename: T
authors.initials: T
authors.lastname: Kärki
authors.forename: M
authors.initials: M
authors.lastname: Kanerva
authors.forename: M
authors.initials: M
authors.lastname: Haapasaari
authors.forename: J
authors.initials: J
authors.lastname: Ollgren
authors.forename: O
authors.initials: O
authors.lastname: Lyytikäinen
mesh_terms: D000369:Aged, 80 and over; D000561:Amdinocillin Pivoxil / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D016001:Confidence Intervals; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008709:Methenamine / Q000627:therapeutic use; D009735:Nursing Homes; D015995:Prevalence; D011795:Surveys and Questionnaires; D014295:Trimethoprim / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000561:Amdinocillin Pivoxil; D014295:Trimethoprim; D008709:Methenamine