RESUMO
Background: The threat of antimicrobial resistance (AMR) is rising, leading to increased illness, death and healthcare costs. In long-term care facilities (LTCFs), high rates of infection coupled with high antibiotic use create a selective pressure for antimicrobial-resistant organisms that pose a risk to residents and staff as well as surrounding hospitals and communities. Antimicrobial stewardship (AMS) is paramount in the fight against AMR, but its adoption in LTCFs has been limited. Methods: This article summarizes factors influencing antibiotic prescribing decisions in LTCFs and the effectiveness of past AMS interventions that have been put in place in an attempt to support those decisions. The emphasis of this literature review is the Canadian LTCF landscape; however, due to the limited literature in this area, the scope was broadened to include international studies. Results: Prescribing decisions are influenced by the context of the individual patient, their caregivers, the clinical environment, the healthcare system and surrounding culture. Antimicrobial stewardship interventions were found to be successful in LTCFs, though there was considerable heterogeneity in the literature. Conclusion: This article highlights the need for more well-designed studies that explore innovative and multifaceted solutions to AMS in LTCFs.
RESUMO
Background: Antimicrobial resistance is a current and pressing issue in Canada. Population-level antibiotic consumption is a key driver. The Public Health Agency of Canada undertook a comprehensive assessment of the Canadian public's knowledge, attitudes and practices in relation to antimicrobial resistance and antibiotic use, to help inform the implementation of public awareness and knowledge mobilization. Methods: Data were collected in three phases: 1) six in-person focus groups (53 participants) to help frame the survey; 2) nationwide survey administration to 1,515 Canadians 18 years and older via cell phone and landline; and 3) 12 online focus groups to analyze survey responses. Survey data is descriptive. Results: A third (33.9%) of survey respondents reported using antibiotics at least once in the previous 12 months, 15.8% more than twice and 4.6% more than five times. Antibiotic use was reported more among 1) those with a household income below $60,000, 2) those with a medical condition, 3) those without a university education and 4) among the youngest adults (18-24 years of age) and (25-34 years of age). Misinformation about antibiotics was common: 32.5% said antibiotics "can kill viruses"; 27.9% said they are "effective against colds and flu"; and 45.8% said they are "effective in treating fungal infections". Inaccurate information was reported more often by those 1) aged 18-24 years, 2) with a high school degree or less and 3) with a household income below $60,000. In focus groups, the time/money trade-offs involved in accessing medical care were reported to contribute to pushing for a prescription or using unprescribed antibiotics, particularly in more remote contexts, while the cost of a prescription contributed to sharing and using old antibiotics. A large majority, across all demographic groups, followed the advice of medical professionals in making health decisions. Conclusion: High trust in medical professionals presents an important opportunity for knowledge mobilization. Delayed prescriptions may alleviate concerns about the time/money constraints of accessing future care. Consideration should be given to prioritizing access to appropriate diagnostic and other technology for northern and/or remote communities and/or medical settings serving many young children to alleviate concerns of needing a prescription or of needing to return later.
RESUMO
Background: The availability of national data on the prevalence of antimicrobial resistant infections in smaller, community, northern and rural acute care hospitals is limited. The objective of this article is to determine the prevalence of infections caused by selected antimicrobial-resistant organisms (AROs) in these smaller hospitals. Methods: A point prevalence survey was conducted by 55 hospitals between February and May 2019 and included representation from all 10 Canadian provinces. Eligible hospitals were those with 350 or fewer beds. Data were collected on hospital characteristics. De-identified patient data were collected on selected infections (pneumonia, urinary tract infections, bloodstream infections, skin/soft tissue infections, surgical site infections, and Clostridioides difficile infections) for selected AROs (methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, extended-spectrum ß-lactamase-producing organisms and carbapenemase-producing organisms). Data on antimicrobial prescribing and infection prevention and control precautions were also collected. Results: A total of 3,640 patients were included in the survey. Median patient age was 73 years, and 52.8% (n=1,925) were female. Selected infections were reported in 14.4% (n=524) of patients, of which 6.9% (n=36) were associated with an ARO infection. Infection prevention and control additional precautions were in place for 13.7% (n=500) of patients, of which half (51.0%, n=255) were due to an ARO. Approximately one third (35.2%, n=1,281) of patients had at least one antimicrobial prescribed. Conclusion: Antimicrobial-resistant organisms remain a serious threat to public health in Canada. The results of this survey warrant further investigation into AROs in smaller Canadian hospitals as a potential reservoir of antimicrobial resistance.