OBJECTIVES The objective of this study is to describe antibacterial use in long-term care facilities and to investigate the determinants of use. DESIGN This study is a quality improvement study conducted from January 2011 to December 2016. SETTING Long-term care facilities in the canton of Vaud, Western Switzerland, were investigated. PARTICIPANTS Twenty-three long-term care facilities were included in this study. INTERVENTION The intervention included the publication of local guidelines on empirical antibacterial therapy and the implementation of physician-pharmacist-nurse quality circles. MEASURES The main outcome was antibacterial use, expressed as defined daily doses (DDD) per 1000 beds per day. Statistical analyses were performed through a 1-level mixed model for repeated measurements. RESULTS Antibacterial use decreased from 45.6 to 35.5 DDD per 1000 beds per day (-22%, P < .01) over the 6-year study period, which was mostly explained by reduced fluoroquinolone use (-59%, P < .001). A decrease in range of use among LTCFs was observed during the study period, and 27% of antibacterial use was related to the WATCH group (antibiotics with higher toxicity concerns and/or resistance potential) according to the AWaRe categorization of the WHO, decreasing from 17.3 DDD per 1000 beds per day to 9.5 (-45%) over the study period. The use of antibacterials from the RESERVE group ("last-resort" treatment options) was very low. CONCLUSION AND IMPLICATIONS A reduction in facility-level antibacterial use and in variability across LTCFs was observed over the study period. The dissemination of empirical antibacterial prescription guidelines and the implementation of physician-pharmacist-nurse quality circles in all LTCFs of the canton of Vaud likely contributed to this reduction. Antibacterials from the WATCH group still represented 27% of the total use, providing targets for future antibiotic stewardship activities.

中文翻译：

---

在瑞士长期护理机构引入指导方针并实施医师-药剂师-护士质量圈后，抗菌药物的使用和设施水平的变化减少

目的 本研究的目的是描述长期护理机构中抗菌药物的使用情况并调查使用的决定因素。设计 本研究是一项于 2011 年 1 月至 2016 年 12 月进行的质量改进研究。调查了瑞士西部沃州的长期护理机构的设置。参与者 本研究包括 23 家长期护理机构。干预 干预包括出版当地经验性抗菌治疗指南和实施医师-药剂师-护士质量圈。措施 主要结果是抗菌药物的使用，表示为每天每 1000 张病床的限定日剂量 (DDD)。通过重复测量的1级混合模型进行统计分析。结果 抗菌药物的使用从 45.6 减少到 35。在 6 年的研究期间，每天每 1000 张病床 5 DDD (-22%, P < .01)，这主要是由于氟喹诺酮类药物的使用减少 (-59%, P < .001)。在研究期间观察到 LTCF 的使用范围有所下降，根据 WHO 的 AWARe 分类，27% 的抗菌药物使用与 WATCH 组（具有较高毒性和/或耐药潜力的抗生素）有关，从在研究期间，每天每 1000 张病床 17.3 DDD 到 9.5 (-45%)。RESERVE 组的抗菌药物（“最后的”治疗方案）的使用率非常低。结论和意义 在研究期间，观察到了设施级抗菌药物使用的减少和 LTCF 的变异性。在沃州的所有 LTCF 中，经验性抗菌处方指南的传播和医师-药剂师-护士质量圈的实施可能促成了这种减少。WATCH 小组的抗菌药物仍占总使用量的 27%，为未来的抗生素管理活动提供了目标。