Factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies

International audience ; BackgroundEffectiveness of antimicrobial stewardship programs in long-term care facilities (LCTFs), where antimicrobial resistance is frequent, remains unclear. We aimed to identify factors associated with antibiotic use in LTCFs.MaterialsWe conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. Participants were LTCF residents, their family, and/or carers. We included quantitative studies investigating factors associated with antibiotic use and performed a qualitative narrative synthesis of the findings. For each factor, if >50% of the studies investigating it showed a statistically significant association in the same direction, we used the term “factor with a trend”. For each factor with a trend, we calculated a causation score (CS) based on the sum of Hill’s criteria (temporality, strength, dose-response relationship, internal consistency, reproducibility; each coded 0/1) and ranging from 0 to 5.ResultsOut of 7,333-screened records, we included 56 articles. Most studies investigated resident-level (n=29/56) and/or facility-level factors (n=31/56), and fewer prescriber-level ones (n=8/56). Resident-level factors with a positive trend (i.e., associated with a higher volume of antibiotic prescriptions, Figure) included comorbidities (CS=5), history of infection (CS=5), indwelling urinary catheter (CS=4), potential signs of infection (e.g., fever, CS=3), positive urine culture/dipstick results (CS=3). Conversely, dementia showed a negative trend (CS=5).Facility-level factors with a positive trend included infection rate (CS=5), prevalence of after-hours medical practitioner visits (CS=4), prevalence of residents with a recent history of urine culture testing (CS=3), staff turnover (CS=2), and number of prescribers (CS=2). The presence of an on-site coordinating physician showed a negative trend (CS=2). At the prescriber-level, higher antibiotic prescribing was ...