Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: systematic review and meta-analysis

Background

Antibiotic misuse is a key contributor to antimicrobial resistance and a concern in long-term aged care facilities (LTCFs). Our objectives were to:  i) summarise key indicators of systemic antibiotic use and appropriateness of use, and ii) examine temporal and regional variations in antibiotic use, in LTCFs (PROSPERO registration CRD42018107125).

Methods & Findings

Medline and EMBASE were searched for studies published between 1990-2021 reporting antibiotic use rates in LTCFs. Random effects meta-analysis provided pooled estimates of antibiotic use rates (percentage of residents on an antibiotic on a single day [point prevalence] and over 12 months [period prevalence]; percentage of appropriate prescriptions). Meta-regression examined associations between antibiotic use, year of measurement and region. 

A total of 90 articles representing 78 studies from 39 countries with data between 1985-2019 were included. Pooled estimates of point prevalence and 12-month period prevalence were 5.2% (95% CI: 3.3-7.9; n=523,171) and 62.0% (95% CI: 54.0-69.3; n=946,127), respectively. Point prevalence varied significantly between regions (Q=224.1, df=7, p

背景
抗生素的滥用是导致抗菌素耐药性的关键因素，并在长期护理机构（LTCFs）中引起关注。本研究旨在：
i) 概括系统抗生素使用及使用适宜性的关键指标；ii) 考察长期护理机构中抗生素使用的时序和地区差异（PROSPERO注册号：CRD42018107125）。
方法与发现
在Medline和EMBASE数据库中检索了1990-2021年间发表的、关于长期护理机构中抗生素使用率的文献。随机效应Meta分析提供了抗生素使用率的汇总估计值（单日抗生素使用居民比例[点现患率]和12个月期间抗生素使用比例[期间现患率];适宜处方比例）。Meta回归分析考察了抗生素使用、测量年份和地区之间的关联。
共纳入了来自39个国家、78项研究的90篇文章，数据范围为1985-2019年。点现患率和12个月期间现患率的汇总估计值分别为5.2%（95%置信区间：3.3-7.9；n=523,171）和62.0%（95%置信区间：54.0-69.3；n=946,127）。点现患率在不同地区间存在显著差异（Q=224.1，df=7，p