De Souza, Nicosha;
Guthrie, Bruce;
Grant, Suzanne;
Lorencatto, Fabiana;
Dickson, Jane;
Herbec, Aleksandra;
Hughes, Carmel;
... Marwick, Charis A; + view all
(2025)
Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK.
Age and Ageing
, 54
(1)
, Article afae288. 10.1093/ageing/afae288.
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Abstract
Background: There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance. // Objective: To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics. // Design: Population-based analyses using administrative data. // Setting and subjects: 148 care-homes in two Scottish regions, with 6633 residents registered with 139 general practices. // Methods: Prescriptions for any antibiotic and for broad-spectrum antibiotics between 1 April 2016 and 31 March 2017 were analysed using cross-classified multilevel negative binomial regression. // Results: For any antibiotics, the mean prescription rate was 6.61 (SD 3.06) per 1000 resident bed-days (RBD). In multivariate analysis, prescribing was associated with resident age [incidence rate ratio (IRR) 1.30 [95% confidence interval 1.19 to 1.41] for 90+ versus <80 years old] and comorbidity (1.88 [1.71 to 2.06] for Charlson Comorbidity Index 3+ versus 0), and the care-home’s sampling rate for microbiological culture (1.53 [1.28 to 1.84] for >7 versus <3.5 samples per 1000 RBD), with residual unexplained variation between care-homes (median IRR 1.29 [1.23 to 1.36]) and general practices (1.11 [1.05 to 1.18]). For broad-spectrum antibiotics, the mean rate was 0.98 (0.92) per 1000 RBD. Broad-spectrum prescribing was also associated with resident age, sex, comorbidity and sampling rate, with larger residual unexplained variation between care-homes (1.56 [1.36 to 1.77]) and general practices (1.51 [1.31 to 1.72]). // Conclusion: Variation in prescribing was influenced by resident case-mix, but there is significant unexplained variation between care-homes and between general practices, indicating a need for antibiotic stewardship to target both.
| Type: | Article |
|---|---|
| Title: | Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/ageing/afae288 |
| Publisher version: | https://doi.org/10.1093/ageing/afae288 |
| Language: | English |
| Additional information: | Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Antibiotic, antimicrobial stewardship, antibiotic prescribing, care-homes, cross-classified, older people |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10209741 |
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