Appropriate Antibiotic Use in Aged Care
Published: 10 July 2023
Published: 10 July 2023
Despite about 12% of aged care residents taking antimicrobials on any given day, only one-quarter of these clients are actually displaying signs of infection (DoHaAC 2023).
Antimicrobials is the broad term used to describe all medications that destroy or slow the growth of disease-causing pathogens (viruses, bacteria, parasites and fungi). Antibiotics are the specific type of antimicrobial used to treat bacterial infections (Australian Government 2022a).
This article will focus on the use of antibiotics in aged care.
Aged care residents are often frail, have weak immune systems and live in close proximity to others, making them more susceptible to developing infections. This, in turn, correlates to increased antibiotic use in these facilities (Australian Government 2022b).
However, with the World Health Organisation declaring antimicrobial resistance (AMR) a major health concern, the prevalence of antibiotics in aged care poses a significant threat to a vulnerable population. In order to minimise the risk of antibiotic-resistant infections emerging and spreading in these environments, it is critical to prescribe and manage antibiotics appropriately (WHO 2021; Australian Government 2022b).
Using antibiotics appropriately means:
(ACQSC 2022)
Appropriate antibiotic prescribing and use is a component of the Aged Care Quality Standards Standard 3: Personal Care and Clinical Care.
Antimicrobial resistance describes the way in which a pathogen (in this case, bacterium) may change upon exposure to an antimicrobial medication, causing it to develop a resistance to that particular medication. The medication used to treat the infection consequently becomes ineffective (WHO 2021).
These infections are notoriously difficult to treat and may result in prolonged hospital stays, disease or death. They can affect anybody and may eventually become impossible to treat (WHO 2021; CDC 2022; Australian Government 2022a).
Of particular concern are multi-resistant organisms (MROs) (colloquially known as ‘superbugs’), which are pathogens that have become resistant to several types of antimicrobials and may become untreatable by existing medicines (WHO 2021).
There is a direct link between antimicrobial resistance and the misuse or overuse of antibiotics. Antimicrobial resistance is a naturally-occurring phenomenon, however, inappropriate antibiotic use accelerates this process (WHO 2021).
In order to reduce the risk of resistant infections emerging and spreading, we must use antibiotics only when they are most needed and perform infection-prevention practices to minimise the likelihood of contracting infections in the first place (Australian Government 2022a).
(Australian Government 2022c)
Despite the widespread use of antibiotics in aged care, there is minimal evidence to guide antimicrobial stewardship in these facilities (Australian Government 2022d).
It may come as no surprise, then, that there are significant issues surrounding the use of antibiotics in aged care.
The 2020 Aged Care National Antimicrobial Prescribing Survey yielded some concerning statistics:
(DoHaAC 2023)
Why is antibiotic overuse so prevalent in aged care? Some of the identified reasons include:
(Australian Government 2022d)
This reveals the key issue: there is a significant knowledge gap among both facilities and staff.
It is essential to always follow antibiotic prescribing guidelines when considering antibiotics as a treatment option.
Remember to always follow your facility’s policies and procedures.
Antibiotic stewardship can be defined as ‘a set of commitments and actions designed to “optimise the treatment of infections while reducing the adverse events associated with antibiotic use” ’ (CDC 2021).
This is a critical skill set required by all staff involved in the prescribing and management of antibiotics.
The Antimicrobial Resistance Initiative provides the following suggestions for health professionals working in aged care:
(Australian Government 2022a)
Furthermore, the Centers for Disease Control and Prevention (2021) has developed the Core Elements of Antibiotic Stewardship for aged care. These include:
In accordance with the Therapeutic Guidelines, antibiotics should, depending on the client’s condition and clinical response, only be used for the shortest length of time possible (TG 2019).
One of the most important components of antibiotic stewardship is practising infection control procedures, and consequently, minimising the transmission of infections that require antibiotic treatment in the first place (Australian Government 2022e).
Facilities should be practising standard precautions for infection prevention and control, including:
(Australian Government 2022e)
While antibiotics are necessary for treating certain infections, Australian aged care facilities are suffering from significant training gaps that lead to antibiotic overuse, and, consequently, may expose their vulnerable clients to antibiotic-resistance infections.
In order to appropriately prescribe and manage antibiotics in aged care settings, it is essential to follow the best available guidelines, as well as your facility’s policies and procedures.
Question 1 of 3
Finish the sentence. Antimicrobial resistance occurs when ...