Symposium on Antibiotic Resistance – Focus on Nursing Homes

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On Tuesday, November 18th, the Chief Epidemiologist, in cooperation with the Hrafnista nursing homes, held a seminar in connection with the annual Antibiotic Resistance Awareness Week.

The seminar was recorded to make the presentations accessible to as many people as possible; here is the link to the recording.

Antimicrobial Resistance

The discovery of antibiotics revolutionized medicine, but with increased use and sometimes misuse, bacteria have gradually developed resistance. Antimicrobial resistance is a growing global problem that can lead to serious illness and death, particularly among older adults.

The prevalence of the most common notifiable resistant organisms, ESBL and MRSA, remains low in Iceland compared to many European countries, although the number of cases here is higher than in the other Nordic countries. ESBL-producing bacteria are often associated with urinary tract infections, especially in older people.

Carbapenemase-producing bacteria, which are resistant to most commonly used antibiotics, are a serious and growing problem in many EU/EEA countries. They are now being detected more frequently in Iceland than before, with a record number detected in 2024.

Fourth Prevalence Study on Healthcare-Associated Infections and Antibiotic Use in European Long-Term Care Facilities (HALT-4)

Data were collected from more than 66,000 residents and 1,097 nursing homes in 18 EU/EEA countries during 2023 and 2024. In Iceland, the study was carried out in three nursing homes with a total of 1,438 care beds, marking the first time Iceland has participated in the project.

In Iceland, 3.5% of nursing home residents had at least one healthcare-associated infection, and around 7% were receiving one or more antibiotics at the time of the study. More than half of all antibiotics were given for prophylactic purposes, which is high proportion compared to other EU/EEA countries. Urinary tract infections were the most common infections.

Antibiotic Use and Management of Urinary Tract Infections in Older Adults Outside Hospitals

Icelanders use more antibiotics than other Nordic nations, but overall use is close to the EU/EEA average. Antibiotic use is proportionally highest among the oldest age groups, especially antibiotics commonly used for urinary tract infections.

Due to this, guidelines for the treatment of urinary tract infections in older adults outside hospitals were issued in 2023. The guidelines address topics such as asymptomatic bacteriuria in older adults, the use of urine tests for diagnosis, recurrent urinary tract infections, and other related challenges.

Infection Prevention and Resistant Bacteria in Nursing Homes

Nursing homes face various challenges in limiting the spread of resistant bacteria, including shortages of single rooms, shared bathrooms, and issues with information flow. There is often pressure to admit residents carrying resistant bacteria despite the limited availability of single rooms. Clear infection prevention and control (IPC) guidelines are essential to ensure resident safety and reduce transmission.

Antibiotic Stewardship in Nursing Homes

Antibiotic stewardship in nursing homes is important for promoting the rational use of antibiotics, which can reduce antibiotic use without increasing complications for residents. The goal is to reduce unnecessary antibiotic prescriptions through education, guidelines, and follow-up. The Chief Epidemiologist has issued posters and workflows to help staff identify urinary tract infections and respond appropriately; the materials have been translated into English, Polish, and Filipino.

Actions

It is important to focus on preventive measures such as infection control and vaccination, along with promoting prudent antibiotic use. In August 2024, the government approved the One Health Action Plan against Antimicrobial Resistance. Actions relating to nursing homes form a significant part of the plan, including monitoring antibiotic use through a centralized database and dashboards, as well as antibiotic stewardship. An implementation and follow-up plan has been established.

The Chief Epidemiologist