Research Open Access
Like 0



Long-term care facilities (LTCFs) are important locations of antimicrobial consumption. Of particular concern is inappropriate prescribing of prophylactic antimicrobials.


We aimed to explore factors related to antimicrobial prophylaxis in LTCFs in Ireland.


The point prevalence surveys of Healthcare-Associated Infections in Long-Term Care Facilities (HALT) were performed in Ireland in May 2013 and 2016. Data were collected on facility (type and stewardship initiatives) and resident characteristics (age, sex, antimicrobial and indication) for those meeting the surveillance definition for a HAI and/or prescribed an antimicrobial.


In 2013, 9,318 residents (in 190 LTCFs) and in 2016, 10,044 residents (in 224 LTCFs) were included. Of the 10% of residents prescribed antimicrobials, 40% were on prophylaxis, most of which was to prevent urinary tract infection. The main prophylactic agents were: nitrofurantoin (39%) and trimethoprim (41%) for urinary tract (UT); macrolides (47%) for respiratory tract and macrolides and tetracycline (56%) for skin or wounds. More than 50% of the prophylaxis was prescribed in intellectual disability facilities and around 40% in nursing homes. Prophylaxis was recorded more often for females, residents living in LTCFs for more than 1 year and residents with a urinary catheter. No difference in prophylactic prescribing was observed when comparing LTCFs participating and not participating in both years.


Forty per cent of antimicrobial prescriptions in Irish LTCFs were prophylactic. This practice is not consistent with national antimicrobial prescribing guidelines. Addressing inappropriate prophylaxis prescribing in Irish LTCFs should be a key objective of antimicrobial stewardship initiatives.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization (WHO). Antimicrobial resistance: global report on surveillance 2014. Geneva: WHO; Apr 2014. Available from: https://www.who.int/drugresistance/documents/surveillancereport/en/
  2. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of health care-associated infections and antimicrobial use in European long-term care facilities. April–May 2013. Stockholm: ECDC; 2014. Available from: https://ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-2
  3. 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; 2010. Available from: https://ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-1
  4. Ricchizzi E, Latour K, Kärki T, Buttazzi R, Jans B, Moro ML, et al. Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill. 2018;23(46):1800394.  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800394  PMID: 30458913 
  5. Health Protection Surveillance Centre (HPSC). Point prevalence survey of healthcare‐associated infections & antimicrobial use in long‐term care facilities (HALT): May 2013. National report 2013. Dublin: HPSC; Mar 2014. Available from: https://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2013report/national2013haltreport/File,14540,en.pdf
  6. National Institute for Health and Care Excellence (NICE). Antibiotic use. London: NICE; 2016. Available from: https://www.nice.org.uk/guidance/conditions-and-diseases/infections/antibiotic-use
  7. Health Service Executive (HSE). Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. Dublin: HSE; 2012. Available from: http://www.antibioticprescribing.ie/
  8. Crnich CJ, Jump R, Trautner B, Sloane PD, Mody L. Optimizing antibiotic stewardship in nursing homes: a narrative review and recommendations for improvement. Drugs Aging. 2015;32(9):699-716.  https://doi.org/10.1007/s40266-015-0292-7  PMID: 26316294 
  9. Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57(5):2326-32.  https://doi.org/10.1128/AAC.02176-12  PMID: 23478961 
  10. Cetti RJ, Venn S, Woodhouse CRJ. The risks of long-term nitrofurantoin prophylaxis in patients with recurrent urinary tract infection: a recent medico-legal case. BJU Int. 2009;103(5):567-9.  https://doi.org/10.1111/j.1464-410X.2008.08008.x  PMID: 18782308 
  11. Vellinga A, Cormican M, Hanahoe B, Murphy AW. Predictive value of antimicrobial susceptibility from previous urinary tract infection in the treatment of re-infection. Br J Gen Pract. 2010;60(576):511-3.  https://doi.org/10.3399/bjgp10X514765  PMID: 20594440 
  12. Ellis C. Long-term antibiotic use may lead to increased risk of cancer. Cranbury: Contagion; 11 Apr 2017. Available from: http://www.contagionlive.com/news/long-term-antibiotic-use-may-lead-to-increased-risk-of-cancer#sthash.nmo5WcqW.dpuf
  13. Enzler MJ, Berbari E, Osmon DR. Antimicrobial prophylaxis in adults. Mayo Clin Proc. 2011;86(7):686-701.  https://doi.org/10.4065/mcp.2011.0012  PMID: 21719623 
  14. Eurostat. EU in the world. 2016 edition. Luxembourg: Publications Office of the European Union; 2016. Available from: https://ec.europa.eu/eurostat/web/products-statistical-books/-/KS-EX-16-001
  15. Rechel B, Grundy YDE, McKee M. How can health systems respond to population ageing? Copenhagen: World Health Organization on behalf of the European Observatory on Health Systems and Policies; 2009. Available from: http://www.euro.who.int/__data/assets/pdf_file/0004/64966/E92560.pdf
  16. Suetens C. Healthcare-associated infections in European long-term care facilities: how big is the challenge? Euro Surveill. 2012;17(35):20259. PMID: 22958606 
  17. Rowe T, Iyer G. Challenges to diagnosis and management of infections in older adults. In: Lindquist LA, editor. New Directions in Geriatric Medicine: Concepts, Trends, and Evidence-Based Practice. Cham: Springer International Publishing; 2016. p. 31-47.
  18. Norman DC. Clinical features of infection in older adults. Clin Geriatr Med. 2016;32(3):433-41.  https://doi.org/10.1016/j.cger.2016.02.005  PMID: 27394015 
  19. Health Service Executive (HSE). European point prevalence survey on healthcare-associated infections and antibiotic use in long‐term care facilities. National report – Republic of Ireland. Dublin: HSE; Nov 2010. Available from: https://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2010report/File,4723,en.pdf
  20. Health Protection Surveillance Centre (HPSC). Point prevalence survey of healthcare-associated infections & antimicrobial use in long-term care facilities: May 2016, Ireland National report. Dublin: HPSC; Mar 2017. Available from: http://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2016report/File,16218,en.pdf
  21. Health Service Executive (HSE). Second national prevalence survey on healthcare-associated infections and antibiotic use in Irish long-term care facilities-National report. Dublin: HSE; Aug 2011. Available from: http://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/haltreports/2011report/File,12869,en.pdf
  22. 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 v.2014. 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.pdf
  23. McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 1991;19(1):1-7.  https://doi.org/10.1016/0196-6553(91)90154-5  PMID: 1902352 
  24. Stone ND, Ashraf MS, Calder J, Crnich CJ, Crossley K, Drinka PJ, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012;33(10):965-77.  https://doi.org/10.1086/667743  PMID: 22961014 
  25. R Core Team. A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2016.
  26. Health Protection Surveillance Centre (HPSC). Healthcare-associated infections & antimicrobial use in long-term care facilities (HALT) May 2016 Survey Protocol – Version 1.0. Dublin: HPSC; 2016. Available from: https://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/documentationandsoftwareforundertakinghalt/File,15614,en.pdf
  27. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer A, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179(4):1379-90.  https://doi.org/10.1016/j.juro.2008.01.068  PMID: 18280509 
  28. Tandan M, Burns K, Murphy H, Hennessy S, Cormican M, Vellinga A. Improving Antimicrobial Prescribing: A Multinomial Model Identifying Factors Associated With First- and Second-Line Prescribing. J Am Med Dir Assoc. 2018;S1525-8610(18)30608-X.  https://doi.org/10.1016/j.jamda.2018.10.028  PMID: 30554988 
  29. Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging Health. 2013;9(5):519-28.  https://doi.org/10.2217/ahe.13.38  PMID: 24391677 
  30. Health Protection Surveillance Centre (HPSC). Guidelines for the prevention of catheter-associated urinary tract infection. Published on behalf of a Strategy for the Control of Antimicrobial Resistance in Ireland (SARI). Dublin: HPSC; 2011. Available from: https://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/guidelines/File,12913,en.pdf
  31. Tandan M, Burns K, Murphy H, Hennessy S, Cormican M, Vellinga A. Antimicrobial prescribing and infections in long-term care facilities (LTCF): a multilevel analysis of the HALT 2016 study, Ireland, 2017. Euro Surveill. 2018;23(46):1800278.  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800278  PMID: 30458910 
  32. Rego LL, Glazer CS, Zimmern PE. Risks of long-term use of nitrofurantoin for urinary tract prophylaxis in the older patient. Urol Sci. 2016;27(4):193-8.  https://doi.org/10.1016/j.urols.2016.07.004 
  33. Kim V, Criner GJ. Chronic bronchitis and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(3):228-37.  https://doi.org/10.1164/rccm.201210-1843CI  PMID: 23204254 
  34. Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, et al. Guidelines for the management of adult lower respiratory tract infections-full versio. Clin Microbiol Infect. 2011;17(s6):E1-59.  https://doi.org/10.1111/j.1469-0691.2011.03672.x  PMID: 21951385 
  35. Aaron SD. Management and prevention of exacerbations of COPD. BMJ. 2014;349(sep22 3):g5237. PMID: 25245156 
  36. Dancer SJ. The problem with cephalosporins. J Antimicrob Chemother. 2001;48(4):463-78.  https://doi.org/10.1093/jac/48.4.463  PMID: 11581224 
  37. Tandan M, Cormican M, Vellinga A. Adverse events of fluoroquinolones vs. other antimicrobials prescribed in primary care: A systematic review and meta-analysis of randomized controlled trials. Int J Antimicrob Agents. 2018;52(5):529-40.  https://doi.org/10.1016/j.ijantimicag.2018.04.014  PMID: 29702230 
  38. Montoya A, Mody L. Common infections in nursing homes: a review of current issues and challenges. Aging Health. 2011;7(6):889-99.  https://doi.org/10.2217/ahe.11.80  PMID: 23264804 
  39. Roche FM, Donlon S, Burns K. Point prevalence survey of healthcare-associated infections and use of antimicrobials in Irish intellectual disability long-term care facilities: 2013. J Hosp Infect. 2016;93(4):410-7.  https://doi.org/10.1016/j.jhin.2016.03.006  PMID: 27112050 
  40. Drennan J, Lafferty A, Treacy MP, Fealy G, Phelan A, Lyons I, et al. Older people in residential care settings. Results of a national survey of staff-resident interactions and conflicts. Dublin: NCPOP, University College Dublin; 2012. Available from: http://www.ncpop.ie/userfiles/file/Older%20People%20in%20Residential%20Care%20Settings_Final%20Proof_28Nov2012.pdf

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error