Antimicrobial prescribing in French nursing homes and interventions for antimicrobial stewardship: a qualitative study.

Autor: Hamard M; Department of Geriatrics, APHP Bichat Hospital, University Paris Cité, Paris, France. marie.hamard@aphp.fr.; Infectious Diseases Department, APHP Bichat Hospital, University Paris Cité, Paris, France. marie.hamard@aphp.fr.; IAME, Inserm, UMR 1137, Université Paris Cite, Paris, France. marie.hamard@aphp.fr., Durand C; IAME, Inserm, UMR 1137, Université Paris Cite, Paris, France., Deconinck L; Infectious Diseases Department, APHP Bichat Hospital, University Paris Cité, Paris, France., Hobson CA; Infectious Diseases Department, APHP Bichat Hospital, University Paris Cité, Paris, France., Lescure FX; Infectious Diseases Department, APHP Bichat Hospital, University Paris Cité, Paris, France.; IAME, Inserm, UMR 1137, Université Paris Cite, Paris, France., Yazdanpanah Y; Infectious Diseases Department, APHP Bichat Hospital, University Paris Cité, Paris, France.; IAME, Inserm, UMR 1137, Université Paris Cite, Paris, France., Peiffer-Smadja N; Infectious Diseases Department, APHP Bichat Hospital, University Paris Cité, Paris, France. nathan.peiffer-smadja@aphp.fr.; IAME, Inserm, UMR 1137, Université Paris Cite, Paris, France. nathan.peiffer-smadja@aphp.fr.; Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, 46 Rue Henri Huchard, Paris, 75018, France. nathan.peiffer-smadja@aphp.fr., Raynaud-Simon A; Department of Geriatrics, APHP Bichat Hospital, University Paris Cité, Paris, France.
Jazyk: angličtina
Zdroj: Antimicrobial resistance and infection control [Antimicrob Resist Infect Control] 2024 Nov 27; Vol. 13 (1), pp. 142. Date of Electronic Publication: 2024 Nov 27.
DOI: 10.1186/s13756-024-01487-1
Abstrakt: Background: Overuse of antibiotics is frequent in nursing homes (NHs) leading to adverse events and selection of resistant bacteria. Antimicrobial stewardship interventions showed heterogeneous effects on reducing inappropriate use of antimicrobials in NHs.
Objectives: This study aimed (1) to analyze antimicrobial prescribing determinants in NHs; (2) to identify which resources for antimicrobial prescribing are used by NHs' physicians (3) understand which antimicrobial stewardship interventions are required and how they should be implemented in NHs.
Methods: We conducted individual semi-directed interviews with NHs' prescribing physicians in Ile-de-France, France. A thematic content analysis was conducted iteratively.
Results: Thirteen interviews were conducted. Participants were mostly women, with a median age of 48 years and a median professional experience in NHs of three years. Participants included medical coordinators, general practitioners and salaried physicians. Main determinants of antimicrobial prescribing in NHs were the perceived risk of infectious complications and discomfort in residents, the difficulty in obtaining microbiological samples and the lack of healthcare professionals to monitor patients. Most participants reported using national guidelines and electronic decision support systems to guide their antimicrobial prescribing. Institutional constraints accentuate situations of doubt and prompt physicians to prescribe antimicrobials "just in case" despite the will to follow guidelines and the known risks of antimicrobial misuse. Physicians stated that proper antimicrobial use in NHs would require a major effort but was not judged a priority as compared to other medical issues. Producing guidelines tailored to the NH's context, performing good practice audits with feedback on antimicrobial prescribing, and reinforcing multidisciplinary relationships and discussions between city and hospital professionals were cited as potential interventions. The role of the medical coordinator was described as central. According to physicians, collaboration among stakeholders, providing support and training during the process might prove effective strategies to ensure successful implementation.
Conclusion: Antimicrobial prescribing is a complex decision-making process involving different factors and actors in NHs. Tailored guidelines, good practice audits, strengthened multidisciplinary collaboration were proposed as key AMS interventions. Physicians emphasized the central role of the medical coordinator supported by stakeholder engagement, collaboration, training and ongoing support for successful implementation.
Competing Interests: Declarations. Ethical approval: The study protocol was approved by the Ethics Committee of Gérond’if, gérontopole d’Ile de France. It followed the framework of the “Reference Methodology” (MR-004) related to the processing of personal data in the context of research not involving the human person (Deliberation No. 2018 − 155 of 3 May 2018). Consent for publication: Written and oral consent were obtained from participants prior to each interview. Sponsor’s role: Gérond’if (le gérontopole d’Ile de France) did not contributed to the design, collection of data, analysis, supervision of the study or the writing of the manuscript. Competing interests: Marie Hamard received funding from Gérond’if (le gérontopole d’Ile de France) to carry out this work. Laurene Deconinck received support for attending meetings and/or travel from Tillotts Pharma. The other authors have no conflicts of interest to declare.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje