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  • br Materials and methods br Results and discussion br


    Materials and methods
    Results and discussion
    Introduction Infections in children aged 0–21 years who reside in long-term care (LTC) facilities are common due to underlying complex medical conditions, use of invasive devices such as urinary catheters and ventilators, and increased exposure to healthcare personnel because of enhanced care needs and developmentally appropriate therapeutic activities [1]. According to the US Centers for Disease Control and Prevention, healthcare-associated infections (HAIs) are localized or systemic responses to infectious agents that were not present nor incubating prior to healthcare facility admission [2]. The average HAI rate in the paediatric population (i.e. the number of incident HAIs occurring over a denominator in which each resident contributes one for each day they are observed) is 4.4 per 1000 resident-days, and includes acute respiratory infections, otitis media, conjunctivitis, urinary tract infections and skin/soft tissue infections [3]. In adult LTC facilities, HAIs due to urinary tract infections, acute respiratory tract infections and skin infections were more prevalent and accounted for the majority of antibiotic prescriptions [4]. Antibiotic use in adult LTC facilities has been well documented, with studies showing that 47–79% of residents receive at least one course of CPI-455 per year [4]. Other studies estimate the rate of antibiotic use as 0.4–23.5 courses per 1000 resident-days [5]. When used appropriately, antibiotics are an essential component of therapeutic medicine in this population [6]. However, misuse of antibiotics, including the treatment of non-bacterial infections, unnecessary application of broad-spectrum agents, inappropriate course lengths and ineffective antimicrobial coverage, exposes pathogens to unnecessary antibiotic agents, which contributes to the development of antibiotic-resistant strains [6]. In light of this, healthcare facilities face new incentives to implement antimicrobial stewardship programmes that include ongoing evaluation of prescribing practices, expert advising, intervention for inappropriate use, and prescriber education. With escalating concerns about antimicrobial resistance and increased need for antimicrobial stewardship, efforts to characterize antimicrobial use in a variety of healthcare settings are critical. Currently, there are almost no data on the use of antimicrobials in the growing population of children with complex medical conditions (e.g. genetic, neurological and metabolic disorders) who reside in LTC facilities, and frequently interface with acute care settings. Therefore, the aim of this study was to describe the use of antibiotics in three paediatric LTC facilities and to describe the factors associated with use.
    Discussion Over the three-year study period, 45% of residents received at least one course of antibiotics for treatment of an HAI, with a mean rate of 2.75 antibiotics per 1000 resident-days. In comparison, studies in adult LTC facilities have documented that 47–79% of residents receive at least one antibiotic course over a one-year period, with a mean rate of four to seven antibiotic courses per 1000 resident-days [4], [5]. Although the overall use of antibiotics in the paediatric LTC facilities described in this study is lower than in adult LTC facilities, the use of antibiotics to treat HAIs is similar: 79% of residents with an HAI received a course of antibiotics in this study, compared with 77–94% of residents with infections in adult LTC facilities [4], [10]. Acute respiratory, urinary and skin/soft tissue infections are cited as the three most common indications for antibiotic use in adult LTC facility studies [4], [11], [12], [13]. In this study of paediatric LTC facilities, acute respiratory infections and skin/soft tissue infections were the first and third most common reasons for initiating antibiotics, but otitis media was the second most common indication and urinary tract infections accounted for only 9% of antibiotic-treated HAIs. This finding reflects age-related differences in risk for these types of infections. The types of antibiotic agents used in this study were also similar to those seen in adult LTC facilities, where use of fluoroquinolones and cephalosporins is common [5], [11], [12]. Additionally, some unique patterns of antibiotic use were noted in the present study, such as inhaled tobramycin for 9% of treated acute respiratory tract infections.