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Antimicrobials are commonly prescribed and contribute to the development of antimicrobial resistance in long-term care facilities (LTCFs). In 2010, the European Centre for Disease Prevention and Control initiated point prevalence surveys (PPS) of healthcare-associated infections and antimicrobial use in European LTCFs, performed by external contractors as the Healthcare-Associated infections in Long-Term care facilities (HALT) projects. Here, we investigated prevalence and characteristics of antimicrobial use and antimicrobial stewardship indicators in European LTCFs in 2016–17. Twenty-four European Union/European Economic Area (EU/EEA) countries, the former Yugoslav Republic of Macedonia and Serbia participated in the third PPS in European LTCFs. Overall, 4.9% (95% confidence interval: 4.8–5.1) of LTCF residents in the EU/EEA participating countries received at least one antimicrobial. The most commonly reported Anatomical Therapeutic Chemical (ATC) groups were beta-lactam antibacterials/penicillins (J01C), other antibacterials (J01X) (e.g. glycopeptide antibacterials, polymyxins), quinolones (J01M), sulfonamides and trimethoprim (J01E), and other beta-lactams (J01D). Urinary tract infections and respiratory tract infections were the main indications for antimicrobial prescription. This PPS provides updated and detailed information on antimicrobial use in LTCFs across the EU/EEA that can be used to identify targets for future interventions, follow-up of these interventions and promote prudent use of antimicrobials in European LTCFs.


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  1. European Union (EU) Eurostat. Eurostat – Population projections 2015 based. Projected old-age dependency ratio. [Accessed: 04 Apr 2018]. Europe: EU Eurostat. Available from: http://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&plugin=1&pcode=tps00200&language=en
  2. European Union (EU) Eurostat. Healthcare resource statistics - beds. Europe: EU Eurostat; 2017. Available from: http://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_resource_statistics_-_beds
  3. World Health Organisation (WHO). Eurostat, OECD. A System of Health Accounts. OECD Publishing. Geneva: WHO; 2011. Available from: http://www.who.int/health-accounts/methodology/sha2011.pdf
  4. Cotter M, Donlon S, Roche F, Byrne H, Fitzpatrick F. Healthcare-associated infection in Irish long-term care facilities: results from the First National Prevalence Study. J Hosp Infect. 2012;80(3):212-6.  https://doi.org/10.1016/j.jhin.2011.12.010  PMID: 22305100 
  5. Rummukainen ML, Mäkelä M, Noro A, Finne-Soveri H, Lyytikäinen O. Assessing prevalence of antimicrobial use and infections using the minimal data set in Finnish long-term care facilities. Am J Infect Control. 2013;41(4):e35-7.  https://doi.org/10.1016/j.ajic.2012.09.007  PMID: 23332375 
  6. Eilers R, Veldman-Ariesen MJ, Haenen A, van Benthem BH. Prevalence and determinants associated with healthcare-associated infections in long-term care facilities (HALT) in the Netherlands, May to June 2010. Euro Surveill. 2012;17(34):20252. PMID: 22939212 
  7. 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(35):20256. PMID: 22958607 
  8. Moro ML, Ricchizzi E, Morsillo F, Marchi M, Puro V, Zotti CM, et al. Infections and antimicrobial resistance in long term care facilities: a national prevalence study. Ann Ig. 2013;25(2):109-18. PMID: 23471448 
  9. Wójkowska-Mach J, Gryglewska B, Czekaj J, Adamski P, Grodzicki T, Heczko PB. Infection control: point prevalence study versus incidence study in Polish long-term care facilities in 2009-2010 in the Małopolska Region. Infection. 2013;41(1):1-8.  https://doi.org/10.1007/s15010-012-0351-5  PMID: 23086684 
  10. Nicolle LE. Infection prevention issues in long-term care. Curr Opin Infect Dis. 2014;27(4):363-9.  https://doi.org/10.1097/QCO.0000000000000071  PMID: 24921424 
  11. van Buul LW, van der Steen JT, Veenhuizen RB, Achterberg WP, Schellevis FG, Essink RTGM, et al. Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc. 2012;13(6):568.e1-13.  https://doi.org/10.1016/j.jamda.2012.04.004  PMID: 22575772 
  12. van den Dool C, Haenen A, Leenstra T, Wallinga J. The role of nursing homes in the spread of antimicrobial resistance over the healthcare network. Infect Control Hosp Epidemiol. 2016;37(7):761-7.  https://doi.org/10.1017/ice.2016.59  PMID: 27052880 
  13. Verhoef L, Roukens M, de Greeff S, Meessen N, Natsch S, Stobberingh E. Carriage of antimicrobial-resistant commensal bacteria in Dutch long-term-care facilities. J Antimicrob Chemother. 2016;71(9):2586-92.  https://doi.org/10.1093/jac/dkw183  PMID: 27246237 
  14. Cassone M, Mody L. Colonization with multidrug-resistant organisms in nursing homes: scope, importance, and management. Curr Geriatr Rep. 2015;4(1):87-95.  https://doi.org/10.1007/s13670-015-0120-2  PMID: 25664233 
  15. van Buul LW, Veenhuizen RB, Achterberg WP, Schellevis FG, Essink RTGM, de Greeff SC, et al. Antibiotic prescribing in Dutch nursing homes: how appropriate is it? J Am Med Dir Assoc. 2015;16(3):229-37.  https://doi.org/10.1016/j.jamda.2014.10.003  PMID: 25458444 
  16. European Centre for Disease prevention and Control (ECDC) and European Commission. (EC). EU Guidelines for the prudent use of antimicrobials in human health. Stockholm: ECDC; Jun 2017. Available from: https://ec.europa.eu/health/amr/sites/amr/files/amr_guidelines_prudent_use_en.pdf
  17. European Centre for Disease Prevention and Control (ECDC). Protocol for point prevalence surveys of healthcare-associated infections and antimicrobial use in European long-term care facilities – version 2.1. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/HALT-3-LTCF-PPS-Protocol-v2.1.pdf
  18. World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2018. Oslo: WHO; 2017. Available from: https://www.whocc.no/filearchive/publications/guidelines.pdf
  19. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare associated infections and antimicrobial use in European long-term care facilities. May–September 2010. Stockholm: ECDC; 2014. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/healthcare-associated-infections-antimicrobial-consumption-point-prevalence-survey-long-term-care-facilities-2010.pdf
  20. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities. April-May 2013. Stockholm: ECDC; 2014. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/healthcare-associated-infections-point-prevalence-survey-long-term-care-facilities-2013.pdf
  21. McClean P, Hughes C, Tunney M, Goossens H, Jans B, Jans BEuropean Surveillance of Antimicrobial Consumption (ESAC) Nursing Home Project Group. Antimicrobial prescribing in European nursing homes. J Antimicrob Chemother. 2011;66(7):1609-16.  https://doi.org/10.1093/jac/dkr183  PMID: 21596722 
  22. Moro ML, Jans B, Cookson B, Fabry J. The burden of healthcare‐associated infections in European long‐term care facilities. Infect Control Hosp Epidemiol. 2010;31(S1) Suppl 1;S59-62.  https://doi.org/10.1086/655989  PMID: 20929373 
  23. Daneman N, Gruneir A, Bronskill SE, Newman A, Fischer HD, Rochon PA, et al. Prolonged antibiotic treatment in long-term care: role of the prescriber. JAMA Intern Med. 2013;173(8):673-82.  https://doi.org/10.1001/jamainternmed.2013.3029  PMID: 23552741 
  24. Ahmed H, Davies F, Francis N, Farewell D, Butler C, Paranjothy S. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. BMJ Open. 2017;7(5):e015233.  https://doi.org/10.1136/bmjopen-2016-015233  PMID: 28554926 
  25. Lo TS, Hammer KD, Zegarra M, Cho WC. Methenamine: a forgotten drug for preventing recurrent urinary tract infection in a multidrug resistance era. Expert Rev Anti Infect Ther. 2014;12(5):549-54.  https://doi.org/10.1586/14787210.2014.904202  PMID: 24689705 
  26. Lee BS, Bhuta T, Simpson JM, Craig JC. Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10(11):CD003265. PMID: 23076896 
  27. Falcone M, Paul M, Yahav D, Orlando G, Tiseo G, Prendki V, et al. Antimicrobial consumption and impact of antimicrobial stewardship programmes in long-term care facilities. Clin Microbiol Infect. 2018;S1198-743X(18)30559-7. PMID: 30076978 
  28. Zomer TP, VAN DER Maaden T, VAN Gageldonk-Lafeber AB, DE Greeff SC, VAN DER Steen JT, Verhoef L. Incidence of pneumonia in nursing home residents with dementia in the Netherlands: an estimation based on three differently designed studies. Epidemiol Infect. 2017;145(11):2400-8.  https://doi.org/10.1017/S0950268817001339  PMID: 28669365 
  29. Alberg T, Holen Ø, Salvesen Blix H, Lindbæk M, Bentele H, Eriksen HM. Antibiotic use and infections in nursing homes. Tidsskr Nor Legeforen 2017;137: 357-61. Available from: https://tidsskriftet.no/en/2017/03/original-article/antibiotic-use-and-infections-nursing-homes
  30. Public health Agency Sweden (PHAS). Punktprevalensmätning av vårdrelaterade infektioner och antibiotikaanvändning inom särskilt boende i Sverige: Svenska-HALT [Point Prevalence Measurement of Health-Related Infections and Antibiotic Use in Special Accommodation in Sweden: Swedish-HALT]. Stockholm: PHAS; 2017. Swedish. Available from: https://www.folkhalsomyndigheten.se/contentassets/e215ba49156d437381688f4c260cd359/protokoll_svenskahalt.pdf

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