Taking the superbug fight to nursing homes

Nursing homes are coming under the spotlight in the ongoing war against superbugs.

A national trial in residential aged care facilities is aiming to find out the level of antibiotic resistant bacteria, and how best practice antibiotic use can assist to control the rise of superbugs.

Monash University and Alfred Health researchers, led by Professor Anton Peleg from the Department of Infectious Diseases and Monash Biomedicine Discovery Institute, with collaborators from Bio21 Institute and University of Sydney, have been given $2.3 million in federal and university funding to start the trial.

“Superbug infections are now a reality, they are here, they are not something for the future,” said Professor Peleg. “We know that misuse of antibiotics is an important risk or driver for superbug infections and our elderly population are particularly vulnerable.”

A 2013 study by Professor Peleg found that more than a third of nursing home residents carried antibiotic-resistant bacteria. Half of those were prescribed antibiotics in the three months prior.

A recent study, from the Columbia University in the United States, found that up to 59 per cent of nursing-home residents have been “colonised” with certain types of superbugs, putting them at more risk of developing a full-blown infection.

“We know that being exposed to antibiotics and high use of antibiotics drives superbug infection,” he said.

The trial aims to improve practice in nursing homes and thus improve the general health of older people.

The unique trial hopes to include 72 nursing homes nationally reaching more than 7000 aged care residents, making it one of the largest in the world.

The trial will determine the level of antibiotic resistant superbug infections in aged care facilities by using cutting-edge genomic analyses to determine the source and spread of individual bacteria. It will also examine the relationship between the spread and the misuse and overuse of antibiotics in individual facilities.

The trial begins later this year. It is supported by the Medical Research Future Fund and will be conducted in collaboration with Bupa, a significant residential aged care provider.

According to Professor Peleg, the trial will be conducted using an innovative “step-wedged” approach, allowing efficient roll-out of the intervention so that best practice can be introduced quickly.

“Our strong team, involving infection and aged care specialists and trial design experts provides the greatest likelihood of improved practice change and impact on the health of our ageing population.” Professor Peleg said.

The trial will look at the impact of introducing a nurse-led antimicrobial practice on the levels of antibiotic resistant bacteria in nursing home residents. The trial will also track resident movements to and from hospitals, to determine the degree to which hospital attendance may increase the superbug load in nursing homes.

Importantly, the study will use advanced genomic techniques to trace the origin and spread of individual strains of bacteria, giving the researchers a map of where and how bacterial infections take hold in nursing homes. Studies have found that a staggering 50 to 80 per cent of residents in aged care facilities will be prescribed an antibiotic, however only one in three will be necessary.