SARA CARLSSON: Management of Respiratory Infections in Primary Care and Infection Control Aspects in Long-Term Care Facilities

Project description

Background
According to the WHO, antibiotic resistance is one of the greatest threats to global health. The main drivers of resistance development are the overuse and misuse of antibiotics in both human and veterinary medicine, as well as healthcare-associated infections and transmission within health and social care settings. In Sweden, the majority of antibiotic prescriptions are issued in outpatient care, with primary care accounting for the largest share. Older adults receive antibiotics more frequently than younger individuals; they are more susceptible to infections, and are at higher risk of severe illness and adverse effects from antibiotic treatment. The most vulnerable older adults in society often reside in long-term care facilities. This became evident during the COVID19 pandemic, when widespread transmission and high mortality rates occurred in these settings.  

Appropriate management of infections and effective control of transmission in primary care and in long-term care facilities is therefore crucial, both from an antibiotic resistance perspective and for the individual patient. 

Aim
The overall aim of the project is to describe how respiratory infections are managed in primary care and to identify risk factors for infections. Furthermore, the project aims to map the prevalence, etiology, and treatment of common infections, as well as the conditions for infection prevention and control practices in long-term care facilities. 

Method
Paper I is a register-based study including 1,113 participants, describing characteristics of patients aged 18 years and older with lower respiratory tract infections who receive antibiotic treatment despite a normal chest Xray. 

Paper II is a repeated cross-sectional study based on data from point prevalence surveys of infections and antibiotic use in long-term care facilities between 2016 and 2023, as well as data from the national quality registry Senior Alert. The study aims to analyze associations between individual risk factors and the occurrence of infections and antibiotic use among residents in long-term care facilities, and how these patterns have changed over time. 

Paper III is a longitudinal cohort study including approximately 300 residents in long-term care facilities. Over a 12month period, the study will map the carriage of pathogenic respiratory viruses and bacteria, the incidence and etiology of respiratory infections, transmission within the facilities, and the prerequisites for infection prevention and control practices. 

Relevance
A deeper understanding of risk factors for infections, and of the rationale behind current management of respiratory infections in primary care and long-term care facilities, can contribute to improved strategies for reducing infection rates and optimizing management. This is essential for preserving the effectiveness of antibiotics in the future and for strengthening patient safety for one of society’s most vulnerable groups.