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Topical antimicrobial prescribing patterns in residents of Australian aged-care facilities: use of a national point prevalence survey to identify opportunities for quality improvement

  • Noleen Bennett
    Correspondence
    Address correspondence to Noleen Bennett, Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia
    Affiliations
    National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia

    Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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  • Katherine Walker
    Affiliations
    Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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  • Kirsty Buising
    Affiliations
    National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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  • Ron Cheah
    Affiliations
    National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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  • Xin Fang
    Affiliations
    National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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  • Robyn Ingram
    Affiliations
    National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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  • Rodney James
    Affiliations
    National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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  • Michael J Malloy
    Affiliations
    Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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  • Karin Thursky
    Affiliations
    National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
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  • Leon J Worth
    Affiliations
    Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia

    The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia

    National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
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Published:March 31, 2021DOI:https://doi.org/10.1016/j.ajic.2021.03.019

      Highlights

      • Topical antimicrobials are frequently prescribed in Australian aged care homes.
      • First line topical antimicrobial therapy is not always prescribed.
      • Antimicrobial stewardship teams should regularly review topical antimicrobial use.

      Background

      Australian residential aged care facilities (RACFs) are encouraged to participate in an annual Aged Care National Antimicrobial Prescribing Survey. This data source was analysed to describe patterns of topical antimicrobial prescribing and thereby provide insight into antimicrobial stewardship (AMS) changes that might be required.

      Methods

      2018 and 2019 survey data was analysed.

      Results

      The overall prevalence of the 52,431 audited residents (629 facilities) who were prescribed 1 or more topical antimicrobials was 2.9%. Of all prescribed antimicrobials (n=4899), 33.0% were for topical application. Most frequently prescribed topical antifungals were clotrimazole (85.3%) and miconazole (9.1%), and antibacterials chloramphenicol (64.1%) and mupirocin (21.8%). Tinea (38.3%) and conjunctivitis (23.8%) were the 2 most common indications. Topical antimicrobials were sometimes prescribed for pro re nata administration (38.8%) and greater than 6 months (11.3%). The review or stop date was not always documented (38.7%).

      Conclusions

      To reduce the possibility of adverse consequences associated with antimicrobial use, antimicrobial stewardship programs in Australian residential aged care facilities should at least ensure mupirocin is appropriately used, first line antimicrobial therapy is prescribed for tinea, chloramphenicol is prescribed for conjunctivitis only if necessary, pro re nata orders for prescriptions are discouraged and to avoid prolonged duration of prescriptions, review or stop dates are always documented.

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      References

        • Lam PL
        • Lee KKH
        • Wong RSM
        • Cheng GYM
        • Bian ZX
        • Chui CH
        • et al.
        Recent advances on topical antimicrobials for skin and soft tissue infections and their safety concerns.
        Crit Rev Microbiol. 2018; 44: 40-78
        • Williamson DA
        • Carter GP
        • Howden BP.
        Current and emerging topical antibacterials and antiseptics: agents, action, and resistance patterns.
        Clin Microbiol Rev. 2017; 30: 827-860
        • Williamson D
        • Ritchie SR
        • Best E
        • Upton A
        • Leversha A
        • Smith A
        • et al.
        A bug in the ointment: topical antimicrobial usage and resistance in New Zealand.
        N Z Med J. 2015; 128: 103-109
      1. Australian Commission on Safety and Quality in Health Care.
        Antimicrobial Stewardship in Australian Health Care Sydney ACSQHC, 2018
      2. Australian Government Aged Care Quality and Safety Commission.
        Guidance and Resources for Providers to support the Aged Care Quality Standards, 2018
        • Schuts EC
        • Hulscher M
        • Mouton JW
        • Verduin CM
        • Stuart J
        • Overdiek H
        • et al.
        Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis.
        Lancet Infect Dis. 2016; 16: 847-856
        • Antibiotic Expert Group
        Therapeutic Guidelines: Antibiotic. Version 16.
        Melbourne Therapeutic Guidelines Limited, Melbourne2019
        • Center for Disease Prevention and Control
        The Core Elements of Antibiotic Stewardship for Nursing Homes Atlanta, GA: US Department of Health and Human Services, CDC.
        2015 (Available at: http://www.cdc.gov/longtermcare/index.html. Accessed May 3, 2021)
      3. European Centre for Disease Prevention and Control. Healthcare associated infections in long term care facilities in Europe: the HALT project. Available at: https://www.ecdc.europa.eu/en/all-topics-z/healthcare-associated-infections-long-term-care-facilities/surveillance-and-disease-13. Accessed May 3, 2021.

        • Heudorf U
        • Boehlcke K
        • Schade M.
        Healthcare-associated infections in long-term care facilities (HALT) in Frankfurt am Main, Germany, January to March 2011.
        Euro Surveill. 2012; 17
        • McClean P
        • Tunney M
        • Gilpin D
        • Parsons C
        • Hughes C.
        Antimicrobial prescribing in residential homes.
        J Antimicrob Chemother. 2012; 67: 1781-1790
        • Selcuk A
        • Yap KZ
        • Wong CL
        • Yang JX
        • Yong PC
        • Chan SY
        • et al.
        A point prevalence study of antimicrobial use and practice among nursing homes in Singapore.
        Drugs Aging. 2019; 36: 559-570
        • Chaplin S.
        Topical antibacterial and antiviral agents: prescribing and resistance.
        Prescriber. 2016; 27: 29-36
        • Howden BP
        • Grayson ML.
        Dumb and dumber–the potential waste of a useful antistaphylococcal agent: emerging fusidic acid resistance in Staphylococcus aureus.
        Clin Infect Dis. 2006; 42: 394-400
        • Expert Group for Dermatology
        Therapeutic Guidelines: Dermatology. Version 3.
        Therapeutic Guidelines Limited, Australia2015
        • Australian Medicines Handbook
        Australian Medicines Handbook Pty Ltd.
        Adelaide, South Australia2021
        • Evans EG
        • Dodman B
        • Williamson DM
        • Brown GJ
        • Bowen RG.
        Comparison of terbinafine and clotrimazole in treating tinea pedis.
        BMJ. 1993; 307: 645-647
        • Schaller M
        • Friedrich M
        • Papini M
        • Pujol RM
        • Veraldi S.
        Topical antifungal-corticosteroid combination therapy for the treatment of superficial mycoses: conclusions of an expert panel meeting.
        Mycoses. 2016; 59: 365-373
        • Dermatology Expert Group
        Therapeutic Guidelines: Dermatology. Version 4..
        Melbourne Therapeutic Guidelines Limited, Melbourne2015
      4. Australian Medicines Handbook: Aged Care Companion.
        Australian Medicines Handbook Pty Ltd, Adelaide2019
      5. Australian Commission on Safety and Quality in Health Care.
        Antimicrobial Stewardship Clinical Care Standard Sydney ACSQHC, 2014
        • The Royal Australian College of General Practitioners
        RACGP aged care clinical guide (Silver Book) Part B.
        Collaboration and multidisciplinary team-based care, 2019
        • Dyar O.J.
        • GT
        • Pulcini C.
        • on behalf of ESGAP (ESCMID Study Group for Antimicrobial stewardshiP)
        Managing responsible antimicrobial use: perspectives across the healthcare system.
        Clin Microbiol Infect. 2017; 23: 441-447
        • National Health and Medical Research Council
        Australian Guidelines for the Prevention and Control of Infection in Healthcare Australia Co, editor.
        Canberra NHMRC, 2019
        • Laube S.
        Skin infections and ageing.
        Ageing Res Rev. 2004; 3: 69-89