Reducing the consumption of antibiotics in nursing homes, key to reducing resistance to antimicrobials

In the context of the European Day for the Prudent Use of Antibiotics (November 18) and World Antimicrobial Awareness Week (November 18-24)

  • According to the analysis of the consortium of organizations that participate in the European HAPPY PATIENT project, and which investigates mechanisms that allow the inappropriate consumption of antibiotics to be reduced by 40% in those countries that have been marked as a priority by the European Commission: Spain, France, Lithuania, Poland and Greece, nursing homes are at the core of the AMR problem
  • One of the project partners, the Region H (Hovedstaden Region) hospital center in Denmark, aims to improve the antibiotic prescription in European geriatric residences, being HAPPY PATIENT the first project of these characteristics that will study the reality in this field in a total of 125 nursing homes in the five target countries
  • The European HAPPY PATIENT project, funded by the 3rd EU-Funded Health Program, is led by the Institut Català de la Salut (ICS) and the Fundació Institut Universitari per a la recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAPJGol) 

In Europe, 5.8% of people living in nursing homes are prescribed an antibiotic, according to a study by Eurosurveillance, dependent on the European Center for Disease Prevention and Control (ECDC). One third of these drugs are used to prevent the development of a bacterial infection. This preventive indication of the antibiotic is inadequate in most cases. Neither organizations nor scientific institutions recommend it, since they contribute to the expansion of antimicrobial resistance (AMR), as well as more complex infections, such as that caused by Clostridium difficile. 

There are EU countries in which the percentage of people living in nursing homes with an antibiotic regimen skyrockets: in Spain, for example, it reaches 11.7%, the highest figure in Europe. The prescription of antimicrobials as prophylaxis to prevent the development of a bacterial infection is one of the strategic lines on which the HAPPY PATIENT consortium is investigating in depth. Prescription as a preventive activity is a practice that is not recommended in most clinical practice guidelines and that, as indicated in Eurosurveillance, is more frequent in people living in nursing homes, for urinary tract and respiratory tract infections.

According to this study, urinary infection prophylaxis was a frequent indication for the use of antimicrobials in nursing homes and, despite the fact that there is evidence that long-term antimicrobial administration can reduce the risk of recurrence of urinary tract infections in women, it carries two risks. On the one hand, the benefit diminishes immediately when the use of antimicrobials is stopped; on the other, long-term administration of antibiotics is associated with a large increase in the proportion of antibiotic-resistant bacteria isolated from urine and faeces. 

Residences, COVID-19 and antibiotic therapy: a threat in the shade

Although there are still no relevant studies linking COVID-19 with microbial resistance, there are indications in thisregard. On the one hand,

SARS-CoV2 infection greatly weakens the immune system of infected people and, in the case of people living in nursing homes, we are dealing with a more immunosuppressed segment of the population.

In this context, «secondary bacterial infections have been extremely common and harmful», says Carl Llor, family doctor, researcher and coordinator of the HAPPY PATIENT project.


And he adds that it is possible that «since secondary infections were a problem with COVID-19, the administration of antibiotics for prophylaxis has multiplied, with the future risks that this entails.»

There are, indeed, positions in this regard, such as that of the GABI Foundation – promoted by the Bill and Melinda Gates Foundation, the WHO, UNICEF and the world bank -, which points out as a risk practices to use mechanical ventilation to treat COVID-19 in intensive care units, because it may pose an increased risk in the proliferation of secondary infections.

For this institution “since secondary infections were known to be a problem with COVID-19, health workers have often prescribed antimicrobials to their patients to be safe. The result is that in Asia, for example, 70% of patients were administered antimicrobials, when less than 10% of them had a secondary infection by bacteria or fungi”.

However, Llor leaves the door open to optimism: COVID-19 may be a unique opportunity to raise awareness and break automatic antibiotic prescription, due to the fact that the perception that the risk of a global health alert is possible has changed ”.

Resistance rates in urinary tract infections, sepsis, sexually transmitted infections, and some forms of diarrhea

During the week of November 18 to 24, the World Antimicrobial Use Awareness Week is celebrated around the world, with the most significant focus on November 18, the European Day for the Prudent Use of Antibiotics.

This date has been chosen to present the latest results on antimicrobial resistance to the community by the European Center for Disease Prevention and Control (ECDC). In their latest reports, the most worrying data pointed to:

A resistance rate to ciprofloxacin, an antibiotic commonly used to treat urinary tract infections, is between 8.4% and 92.9% in Escherichia coli and between 4.1% and 79.4% in klebsiella pneumoniae, as recently reported by the Global Antimicrobial Use and Resistance Surveillance System (GLASS).

Antibiotic-resistant strains of Mycobacterium are already a real threat in containing the global tuberculosis epidemic.

For its part, the WHO estimates that in 2018 there were around half a million new cases of rifampicin-resistant tuberculosis (RR-TB) identified worldwide. As for MDR-TB tuberculosis, it has also been found to be resistant to the two most powerful anti tuberculosis drugs ever created. Less than 60% of those treated for MDR / RR-TB were successfully cured.


The HAPPY PATIENT Project Consortium is made up of the IDIAPJGol Research Institute and the Institut Català de la Salut (ICS), the University of Copenhagen (UCPH), the University of Southern Denmark (SDU) and its Odense General Practice Research Unit (RUPO), the Norwegian Research Center (NORCE), the Capital Region of Denmark, the Rijksuniversiteit Groningen (RUG), the University of Las Palmas de Gran Canaria (ULPGC) and Fundación Canaria Parque Científico Tecnológico de la Universidad de Las Palmas de Gran Canaria (FCPCT), the University Hospital of Nice (CHU de Nice), My Family Doctor (Mano Seimos Gydytojas), the Medical University of Lodz (MUL), the University of Crete (UoC), the Spanish Society of Family and Community Medicine (SEMFYC), the European Association of Clinical Pharmacology (EACPT), the University Hospital of Rennes (CHU Rennes) and the International University of Catalonia – Patient Institute (UIC).