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SDG 3: Antimicrobial resistance

Abstract

INTRODUCTION

Data for healthcare-associated infections (HAI) and antibiotic use in long-term care facilities (LTCF) in Switzerland are lacking but are necessary to take actions.

AIM

We aimed to estimate HAI prevalence and antibiotic use and to record existing structure and process indicators in the area of infection prevention/antibiotic use in Swiss LTCF.

METHODS

We invited all Swiss LTCF for this PPS in September 2024 using the adapted Healthcare-Associated Infections in European Long-Term Care Facilities (HALT)-4 protocol. The proportion of residents with HAI and systemic antibiotic treatment was calculated for a representative sample, stratified by language region and size. We assessed resident-level and institutional risk factors for HAI in all participating institutions, using random-effects logistic regression.

RESULTS

We included 94 LTCF (7,244 residents), whereof 49 LTCFs (3,375 residents) belonged to the representative sample. Median age of residents in the representative sample was 87 years (range: 36–107) and 2,334 (69.2%) were female. Prevalence of HAI was 2.2% (95% confidence interval (CI): 1.7–2.7); 2.7% (95% CI: 2.2–3.3) were receiving antibiotic treatment, with highest use in LTCF in French-speaking cantons (5.9%; 95% CI: 4.2–7.5). Urinary tract (46%) and respiratory infections (20%) were most common, aminopenicillins (26%) and nitrofurantoin (19%) the most commonly used antimicrobials. The strongest independent risk factor for HAI was presence of urinary catheters (adjusted odds ratio = 2.65; 95% CI: 1.71–4.11).

DISCUSSION

Prevalence of HAI and antibiotic use in Swiss LTCFs were comparable to the European average from 2023/24. There are regional differences in antibiotic consumption. Urinary catheterisation, potentially modifiable, was the most important risk factor for HAI.

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2025-09-25
2026-04-18
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References

  1. Cassini A, Plachouras D, Eckmanns T, Abu Sin M, Blank HP, Ducomble T, et al. Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med. 2016;13(10):e1002150.  https://doi.org/10.1371/journal.pmed.1002150  PMID: 27755545 
  2. Al-Tawfiq JA, Tambyah PA. Healthcare associated infections (HAI) perspectives. J Infect Public Health. 2014;7(4):339-44.  https://doi.org/10.1016/j.jiph.2014.04.003  PMID: 24861643 
  3. Ricchizzi E, Sasdelli E, Leucci AC, Fabbri E, Caselli L, Latour K, et al. Incidence of health-care-associated infections in long-term care facilities in nine European countries: a 12-month, prospective, longitudinal cohort study. Lancet Infect Dis. 2025.  https://doi.org/10.1016/S1473-3099(25)00217-8 
  4. Holmes AH, Moore LSP, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176-87.  https://doi.org/10.1016/S0140-6736(15)00473-0  PMID: 26603922 
  5. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities 2023-2024. Stockholm: ECDC; 2025. Available from: https://www.ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-6
  6. Héquet D, Kessler S, Rettenmund G, Lemmenmeier E, Qalla-Widmer L, Gardiol C, et al. Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland. J Hosp Infect. 2021;117:172-8.  https://doi.org/10.1016/j.jhin.2021.08.018  PMID: 34428504 
  7. CURAVIVA. Heimeintritt und Aufenthalt. [Entry into and stay in a care home]. Bern: Curaviva. [Accessed: 1 Jul 2025]. German. Available from: https://www.curaviva.ch/Fachwissen/Eintritt-Aufenthalt/PyCZW
  8. 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 4.0. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/PRO-20221017-419_Final.pdf
  9. Swiss Federal Office of Statistics. Angebot der sozialmedizinischen Institutionen nach Grossregion und Kanton des Betriebes, Beherbergungstyp und rechtlich-wirtschaftlichem Status des Betriebes. [Offers from the socio-medical institutions according to the major region and canton of the establishment, the type of accommodation and the legal and economic status of the establishment]. Neuchâtel: Federal Office of Statistics. [Accessed 14 January 2025]. German. Available from: https://www.pxweb.bfs.admin.ch/pxweb/en/px-x-1404010100_301/px-x-1404010100_301/px-x-1404010100_301.px
  10. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516.  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516  PMID: 30458912 
  11. Inghammar M, Svanström H, Voldstedlund M, Melbye M, Hviid A, Mølbak K, et al. Proton-pump inhibitor use and the risk of community-associated Clostridium difficile infection. Clin Infect Dis. 2021;72(12):e1084-9.  https://doi.org/10.1093/cid/ciaa1857  PMID: 33629099 
  12. Willems RPJ, van Dijk K, Ket JCF, Vandenbroucke-Grauls CMJE. Evaluation of the association between gastric acid suppression and risk of intestinal colonization with multidrug-resistant microorganisms: a systematic review and meta-analysis. JAMA Intern Med. 2020;180(4):561-71.  https://doi.org/10.1001/jamainternmed.2020.0009  PMID: 32091544 
  13. Bates D, Maechler M, Bolker B, Walker S, Bojesen Christensen RH, Singmann H, et al. lme4: linear mixed-effects models using 'Eigen' and S4. GitHub. [Accessed: 11 Feb 2025. Available from: https://cran.r-project.org/package=lme4
  14. Dwyer LL, Harris-Kojetin LD, Valverde RH, Frazier JM, Simon AE, Stone ND, et al. Infections in long-term care populations in the United States. J Am Geriatr Soc. 2013;61(3):342-9.  https://doi.org/10.1111/jgs.12153  PMID: 23496650 
  15. Heudorf U, Schulte D. Surveillance nosokomialer Infektionen in einem Altenpflegeheim. Inzidenz und Risikofaktoren [Surveillance of nosocomial infections in a long-term care facility. Incidence and risk factors]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2009;52(7):732-43. German.  https://doi.org/10.1007/s00103-009-0869-6  PMID: 19517072 
  16. 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 
  17. 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 
  18. Eriksen HM, Koch AM, Elstrøm P, Nilsen RM, Harthug S, Aavitsland P. Healthcare-associated infection among residents of long-term care facilities: a cohort and nested case-control study. J Hosp Infect. 2007;65(4):334-40.  https://doi.org/10.1016/j.jhin.2006.11.011  PMID: 17275954 
  19. Mody L, Greene MT, Meddings J, Krein SL, McNamara SE, Trautner BW, et al. A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Intern Med. 2017;177(8):1154-62.  https://doi.org/10.1001/jamainternmed.2017.1689  PMID: 28525923 
  20. Vijh R, Ng CH, Shirmaleki M, Bharmal A. Factors associated with transmission of COVID-19 in long-term care facility outbreaks. J Hosp Infect. 2022;119:118-25.  https://doi.org/10.1016/j.jhin.2021.11.008  PMID: 34808312 
  21. Scanferla G, Héquet D, Graf N, Münzer T, Kessler S, Kohler P, et al. COVID-19 burden and influencing factors in Swiss long-term-care facilities: a cross-sectional analysis of a multicentre observational cohort. Swiss Med Wkly. 2023;153:40052.  https://doi.org/10.57187/smw.2023.40052  PMID: 37011609 
  22. Houben F, den Heijer CDJ, Dukers-Muijrers NHTM, Daamen AMJ, Groeneveld NS, Vijgen GCM, et al. Facility- and ward-level factors associated with SARS-CoV-2 outbreaks among residents in long-term care facilities: A retrospective cohort study. Int J Infect Dis. 2023;130:166-75.  https://doi.org/10.1016/j.ijid.2023.03.007  PMID: 36906124 
  23. Moyo P, Zullo AR, McConeghy KW, Bosco E, van Aalst R, Chit A, et al. Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study. BMC Geriatr. 2020;20(1):47.  https://doi.org/10.1186/s12877-020-1457-8  PMID: 32041538 
  24. Fernández-Martínez NF, Rivera-Izquierdo M, Ortiz-González-Serna R, Martínez-Ruiz V, Lardelli-Claret P, Aginagalde-Llorente AH, et al. Healthcare-associated infections by multidrug-resistant bacteria in Andalusia, Spain, 2014 to 2021. Euro Surveill. 2023;28(39):2200805.  https://doi.org/10.2807/1560-7917.ES.2023.28.39.2200805  PMID: 37768559 
  25. Achermann R, Suter K, Kronenberg A, Gyger P, Mühlemann K, Zimmerli W, et al. Antibiotic use in adult outpatients in Switzerland in relation to regions, seasonality and point of care tests. Clin Microbiol Infect. 2011;17(6):855-61.  https://doi.org/10.1111/j.1469-0691.2010.03348.x  PMID: 20731682 
  26. 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 
  27. Piggott KL, Trimble J, Leis JA. Reducing unnecessary urine culture testing in residents of long term care facilities. BMJ. 2023;382:e075566.  https://doi.org/10.1136/bmj-2023-075566  PMID: 37558239 
  28. Trautner BW, Greene MT, Krein SL, Wald HL, Saint S, Rolle AJ, et al. Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel. Infect Control Hosp Epidemiol. 2017;38(1):83-8.  https://doi.org/10.1017/ice.2016.228  PMID: 27697086 
  29. Kohler P, Seiffert SN, Kessler S, Rettenmund G, Lemmenmeier E, Qalla Widmer L, et al. Molecular epidemiology and risk factors for extended-spectrum β-lactamase-producing Enterobacterales in long-term care residents. J Am Med Dir Assoc. 2022;23(3):475-481.e5.  https://doi.org/10.1016/j.jamda.2021.06.030  PMID: 34297981 
  30. Carman WF, Elder AG, Wallace LA, McAulay K, Walker A, Murray GD, et al. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial. Lancet. 2000;355(9198):93-7.  https://doi.org/10.1016/S0140-6736(99)05190-9  PMID: 10675165 
First nationwide point-prevalence survey on healthcare-associated infections and antibiotic use in long-term care facilities, Switzerland, September 2024
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Domenica+Flury&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Flury Domenica</a>, <a href="/search?value1=Emmanouil+Glampedakis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Glampedakis Emmanouil</a>, <a href="/search?value1=Nando+Bloch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bloch Nando</a>, <a href="/search?value1=Celine+Gardiol&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gardiol Celine</a>, <a href="/search?value1=Fabian+Gr%C3%A4ssli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Grässli Fabian</a>, <a href="/search?value1=Simone+Kessler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kessler Simone</a>, <a href="/search?value1=Jacqueline+Kuhn&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuhn Jacqueline</a>, <a href="/search?value1=Tanja+Kurdovsky&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kurdovsky Tanja</a>, <a href="/search?value1=Stefan+P+Kuster&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuster Stefan P</a>, <a href="/search?value1=Vanja+Piezzi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Piezzi Vanja</a>, <a href="/search?value1=Matthias+Schlegel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schlegel Matthias</a>, <a href="/search?value1=Simone+Toppino&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Toppino Simone</a>, <a href="/search?value1=Philipp+Kohler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kohler Philipp</a></span>. First nationwide point-prevalence survey on healthcare-associated infections and antibiotic use in long-term care facilities, Switzerland, September 2024. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(38):pii=2500221. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.38.2500221" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.38.2500221</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 27 Mar 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 17 Jul 2025 </span> </p>
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