Are we too quick to give aged care residents antibiotics? This study suggests we are

Key points:

• Antimicrobial resistance is considered one of the top threats to global health by the World Health Organization (WHO) and is largely driven by the antibiotic overuse that leads to bacteria changing over time and no longer responding to previously effective treatments
• Antimicrobial stewardship (AMS) is defined as an ongoing effort by a health service organisation to optimise antimicrobial use among patients ‘to improve patient outcomes, ensure cost-effective therapy and reduce adverse sequelae of antimicrobial use (including antimicrobial resistance)
• According to the most recent report from Antimicrobial Use and Resistance in Australia Surveillance System, around 10 million people in Australia are prescribed at least one antibiotic every year under the PBS, representing approximately 40% of the population

A new study out of an Adelaide University analysing wastewater samples from several aged care and retirement facilities has uncovered worrying signs of antimicrobial resistance (AMR) in at least one facility.

High levels of bacterial resistance against three common antibiotics – ceftazidime, cefepime and ciprofloxacin – were identified in one aged care residential facility. A second facility recorded above-average levels of antimicrobial resistance to gentamicin, putting residents’ health at risk.

These antibiotics are used to treat a variety of bacterial infections, including pneumonia, gynaecological, urinary and respiratory tract infections, and those affecting bones and joints.

University of South Australia microbiologist, Associate Professor Rietie Venter, led the study and said AMR is a concerning trend in aged care facilities.

Assoc Prof Venter’s team analysed samples of wastewater from three facilities and found unique patterns of antimicrobial resistance in each location, which may be related to whether or not antimicrobial stewardship programs have been implemented.

Although the wastewater study was confined to three sites and 300 residents, the findings suggest a much wider problem and are a clear warning to aged care facilities to implement stricter policies when it comes to medication use.

Assoc Prof Venter said, “As well as increasing death rates, AMR can lengthen illness recovery times, especially for immunocompromised people who make up a high proportion of people in aged care homes.”

The Australian Commission on Safety and Quality in Health Care (ACSQHC) says general rates of antimicrobial resistance have not significantly changed in the past two years. There are exceptions to this, including increasing resistance to ceftriaxone and fluoroquinolones. 

Both of these antibiotics are widely used in aged care settings, despite clinical guidelines recommending them as ‘last resort’ drugs.

The latest ACSQHC report found that antimicrobials continue to be prescribed at high rates in aged care facilities and that there were high rates of reporting for suspected skin and soft tissue, urinary tract and respiratory tract infections.

“Given our ageing population, there is a crucial need to regularly monitor these facilities and mitigate the threat of AMR.”

Chair of The Royal Australian College of General Practitioners (RACGP) Specific Interests Aged Care Doctor Anthony Marinucci said that prioritising antimicrobial stewardship programs that promote “careful and responsible management of medications used to treat or prevent infections” is key in addressing the issue.

“Successive Aged Care National Antimicrobial Prescribing Survey reports show that antimicrobials are being used in aged care for conditions where they are not required, of inappropriate duration or for prevention of infection, all leading to an increased risk of antimicrobial resistance,” he said.

“Antimicrobial stewardship is a multidisciplinary approach to promoting and supporting best practice antimicrobial prescribing [and] should remain a focus for quality improvement in aged care.”