Infections and antibiotic treatment in long-term care facilities: results from 1-year cross sectional study in three Polish settings

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BACKGROUND: Health care-associated infections (HAIs) in long-term care facilities (LTCFs) represent a significant issue within the health care system. With the expected increase in the geriatric population, they will pose an increasing challenge to the health care system. The aim of this study was to analyse and compare the epidemiology of HAIs and the use of antimicrobial agents in Polish LTCFs participating in a longitudinal study based on the European Centre for Disease Control and Prevention (ECDC). MATERIALS AND METHODS: This study utilized the H4LS: Healthcare-Associated Infections in Long-Term Care Facilities-Longitudinal Study protocol from ECDC. Additionally, data on antibiotic consumption, reflecting the distribution according to specific groups and the WHO AWaRe classification system, were collected. The study was conducted in nursing homes. Patient observation took place from February 1, 2022, to January 31, 2023. RESULTS: This study included 269 patients residing in three nursing homes. The average age of the residents was 84.06 years (SD 10.2). To varying degrees, cognitive impairments were present in 86.99% of the residents; mobility limitations in 89.96%; urinary or faecal incontinence in 92.19%; urinary catheters in 14.5%; and vascular catheters in 6.69%. Comparison between settings revealed significant differences only for Charlston comorbidity index and urinary/ fecal incontinence. A total of 420 infections were recorded among 183 residents. The cumulative incidence rate was 5.2 per 1000 patient-days. The most prevalent infections were pneumonia (35.24%) and urinary tract infections (20.95%). For pneumonia and conjunctivitis there were also observed differences in incidence between study settings. Among the HAIs, 382 (90.95%) were treated with antimicrobial agents. The most commonly used antibiotics were third-generation cephalosporins (20.83%) and penicillin combinations, including beta-lactamase inhibitors (17.80%) and fluoroquinolones (13.83%). However, significant differences were observed for antibiotic treatment pattersn in study settings. In stratification according to the WHO AWaRe classification, the most commonly used antimicrobials belonged to the Watch group (49%). CONCLUSIONS: These results highlight the urgent need for the effective implementation of infection prevention and control in LTCFs. The implementation should be performed at the regional or country level because only multicentre studies allow us to obtain the most reliable data. Our results revealed a lack of antimicrobial stewardship in the study of LTCFs. This situation also demands quick interventions.

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