To identify factors contributing to general and inappropriate antibiotic prescription among long-term care facility (LTCF) residents with lower respiratory tract infections (LRTI).
Prospective multicentric observational study. Residents with LRTI were recruited among 32 LTCFs in Western Switzerland during winter 2022-2023. Residents underwent lung ultrasound (LUS) within three days of LRTI onset, serving as the pneumonia diagnosis reference standard. To identify factors among demographics, vital signs, diagnostic tests, and LTCF characteristics associated with (i) antibiotic prescription and (ii) inappropriate prescription, we used multivariable logistic regression and backward selection with a p-value cutoff of <0.1.
We included 114 residents, 63% female, median age of 87 years. Overall, 59 (52%) residents had diagnostic tests performed: 50 (44%) had a PCR for respiratory viruses and 16 (14%) had a blood test with CRP and/or blood count. A total of 63 (55%) residents received antibiotics. Factors associated with antibiotic prescriptions were CFS ≥ 7 (aOR 6.8, 95% CI 1.5-24.4), oxygen saturation < 92% (3.5, 1.4-8.8), performing a blood test (0.1, 0.0-0.6), rural LTCFs (0.3, 0.1-0.7), and female physician (0.3, 0.1-0.8). Among residents receiving antibiotics, 48 (74%) had inappropriate prescriptions, with as only protective factor performing a respiratory virus PCR test (0.1, 0.0-0.4).
While half of LRTI residents received antibiotics, falling within lower ranges of European LTCFs prescription rates (53-80%), most antibiotic prescriptions were inappropriate. Utilization of diagnostic tests correlates with lower overall and inappropriate prescription, advocating for their use to optimize prescription practices in LTCFs.