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International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 1044–1050 | Cite as

Antimicrobial use and drug–drug interactions among nursing home residents in Singapore: a multicentre prevalence study

  • Aysu Selcuk
  • Christine B. Teng
  • Sui Yung Chan
  • Kai Zhen YapEmail author
Research Article
  • 124 Downloads

Abstract

Background With the Ministry of Health’s projected increase in nursing home beds and optimization of antimicrobial use in health care settings, it is therefore timely to consider baseline prevalence and patterns of antimicrobial use at nursing homes in Singapore as well as to evaluate the prevalence of potential clinically significant drug–drug interactions involving antimicrobials. Objective The primary objective was to determine the prevalence and patterns of antimicrobial use at nursing homes in Singapore. The secondary objective was to evaluate the prevalence of potential clinically significant drug–drug interactions involving antimicrobials. Setting Four nursing homes in Singapore. Method A retrospective cross-sectional study was conducted among nursing home residents. The antimicrobial prevalence, defined daily doses, days of therapy, and potential drug–drug interactions were determined using data from archived resident medication prescribing and administration records. Main outcome measure Prevalence and patterns of antimicrobial use, drug–drug interactions involving antimicrobials. Results Among 707 residents (mean age: 80.7 ± 8.8 years, female: 57.1%), 10% used antimicrobials during the study month, with a 1-day point prevalence of 3%. The utilization rates of antimicrobials were 28.9 defined daily doses/1000 resident-days and 24.8 days of therapy/1000 resident-days. Potential drug–drug interactions involving antimicrobials were identified among 32 of the 70 (46%) residents who were prescribed antimicrobials. Of these, 26 (81%) residents had 43 potential clinically significant drug–drug interactions. Conclusions The prevalence and utilization rates of antimicrobial use in Singapore nursing homes appear to be low. Yet, potential clinically significant drug–drug interactions are prevalent.

Keywords

Antimicrobial use Drug interactions Elderly Nursing home Prevalence Singapore 

Notes

Funding

This study did not receive any external funding.

Conflicts of interest

The authors declare no conflict of interest.

References

  1. 1.
    Centers for Disease Control and Prevention. The core elements of antibiotic stewardship. https://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Accessed 30 Jan 2018.
  2. 2.
    Nicolle LE, Bentley DW, Garibaldi R. Neuhaus EG, Smith PW. Antimicrobial use in long-term-care facilities, SHEA Long-Term-Care Committee. Infect Control Hosp Epidemiol. 2000;21(8):537–45.CrossRefGoogle Scholar
  3. 3.
    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;32:699–716.CrossRefGoogle Scholar
  4. 4.
    Daneman N, Bronskill SE, Gruneir A, Newman AM, Fischer HD, Rochon PA, et al. Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents. JAMA Intern Med. 2015;175(8):1331–9.CrossRefGoogle Scholar
  5. 5.
    van Buul LW, Veenhuizen RB, Archterberg WP, Schellevis FG, Essink RT, 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.CrossRefGoogle Scholar
  6. 6.
    Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–77.CrossRefGoogle Scholar
  7. 7.
    Improving the intermediate and long-term care sector for the benefit of patients. http://getforme.com/. Accessed 30 Jan 2018.
  8. 8.
    Wang P, Yap P, Koh G, Chong JA, Davies LJ, Dalakoti M, et al. Quality of life and related factors of nursing home residents in Singapore. Health Qual Life Outcomes. 2016;14(1):112–20.CrossRefGoogle Scholar
  9. 9.
    Ministry of Health Singapore Launch of National Strategic Action Plan on Antimicrobial Resistance. https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2017/launch-ofnational-strategic-action-plan-on-antimicrobial-resist.html. Accessed 30 Jan 2018.
  10. 10.
    McClean P, Hughes C, Tunney M, Goossens H, Jans B, European Surveillance of Antimicrobial Consumption (ESAC) Nursing Home Project Group. Antimicrobial prescribing in European nursing homes. J Antimicrob Chemother. 2011;66(7):1609–16.CrossRefGoogle Scholar
  11. 11.
    Daneman N, Gruneir A, Newman A, Fischer HD, Bronskill SE, Rochon PA, et al. Antibiotic use in long-term care facilities. J Antimicrob Chemother. 2011;66(12):2856–63.CrossRefGoogle Scholar
  12. 12.
    Smith M, Atkins S, Worth L, Richards M, Bennett N. Infections and antimicrobial use in Australian residential aged care facilities: a comparison between local and international prevalence and practices. Aust Health Rev. 2013;37(4):529–34.CrossRefGoogle Scholar
  13. 13.
    Thompson ND, LaPlace L, Epstein L, Thompson D, Dumyati G, Concannon C, et al. Prevalence of antimicrobial use and opportunities to improve prescribing practices in U.S. nursing homes. J Am Med Dir Assoc. 2016;17(12):1151–3.CrossRefGoogle Scholar
  14. 14.
    Wouters H, Scheper J, Koning H, Brouwer C, Twisk JW, van der Meer H, et al. Discontinuing inappropriate medication use in nursing home residents: a cluster randomized controlled trial. Ann Intern Med. 2017;167(9):609–17.CrossRefGoogle Scholar
  15. 15.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefGoogle Scholar
  16. 16.
    Buntinx F, Niclaes L, Suetens C, Jans B, Mertens R, Van den Akker M. Evaluation of Charlson’s comorbidity index in elderly living in nursing homes. J Clin Epidemiol. 2002;55(11):1144–7.CrossRefGoogle Scholar
  17. 17.
    Ministry of Health Singapore Residents Assessment Form. https://elis.moh.gov.sg/elis/publishInfo.do?task=download&pkId=167. Accessed 30 Jan 2018.
  18. 18.
    World Health Organization Anatomic Therapeutic Code & Defined Daily Dose Index. https://www.whocc.no/atc_ddd_index/. Accessed 30 Jan 2018.
  19. 19.
    Blix HS, Roed J, Sti MO. Large variation in antibacterial use among Norwegian nursing homes. Scand J Infect Dis. 2007;39(6–7):536–41.CrossRefGoogle Scholar
  20. 20.
    Lexicomp Drug Interaction Checker for UpToDate. http://www.uptodate.com.libproxy1.nus.edu.sg/crlsql/inter-act/frameset.jsp. Accessed 30 Jan 2018.
  21. 21.
    Latour K, Catry B, Broex E, Vankerckhoven V, Muller A, Stroobants R, et al. Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey. Pharmacoepidemiol Drug Saf. 2012;21(9):937–44.CrossRefGoogle Scholar
  22. 22.
    Pakyz AL, Dwyer LL. Prevalence of antimicrobial use among United States nursing home residents: results from a national survey. Infect Control Hosp Epidemiol. 2010;31(6):661–2.CrossRefGoogle Scholar
  23. 23.
    Fleet E, Rao GG, Patel B, Cookson B, Charlett A, Bowman C, et al. Impact of implementation of a novel antimicrobial stewardship tool on antibiotic use in nursing homes: a prospective cluster randomized control pilot study. J Antimicrob Chemother. 2014;69(8):2265–73.CrossRefGoogle Scholar
  24. 24.
    Jump RL, Olds DM, Seifi N, Kypriotakis G, Jury LA, Peron EP, et al. Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use. Infect Control Hosp Epidemiol. 2012;33(12):1185–92.CrossRefGoogle Scholar
  25. 25.
    Rummukainen ML, Kärki T, Kanerva M, Haapasaari M, Ollgren J, Lyytikäinen O. Antimicrobial prescribing in nursing homes in Finland: results of three point prevalence surveys. Infection. 2013;41(2):355–60.CrossRefGoogle Scholar
  26. 26.
    American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  27. 27.
    English BA, Dortch M, Ereshefsky L, Jhee S. Clinically significant psychotropic drug–drug interactions in the primary care setting. Curr Psychiatry Rep. 2012;14(4):376–90.CrossRefGoogle Scholar
  28. 28.
    Arayne MS, Sultana N, Hussain F. Interactions between ciprofloxacin and antacids–dissolution and adsorption studies. Drug Metab Drug Interact. 2005;21(2):117–29.CrossRefGoogle Scholar
  29. 29.
    Patel AM, Shariff S, Bailey DG, Juurlink DN, Gandhi S, Mamdani M, et al. Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study. Ann Intern Med. 2013;158(12):869–76.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pharmacy, Faculty of ScienceNational University of SingaporeSingaporeSingapore

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