Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate professor Anne Holm, University of Copenhagen,
- Second opponent: Director Anette Fosse, UiT - The Arctic University of Norway,
- Third member and chair of the evaluation committee: Associate professor Eirik Abildsnes, University of Oslo
Chair of the Defence
Professor Nina Køpke Vøllestad, University of Oslo
Principal Supervisor
Associate professor Maria Romøren, University of Oslo
Summary
To hamper further rise of antibiotic resistance, effective measures aiming to reduce unnecessary antibiotic use needs to be developed and implemented. Previous studies have concluded that there is potential for improved antibiotic use in nursing homes (NHs).
This thesis explores antibiotic use and stewardship in Norwegian NHs through a multi-methods approach, including a descriptive baseline data analysis, a controlled multifaceted antibiotic improvement intervention, and a qualitative study of NH healthcare professionals’ perceptions on barriers and facilitators of prudent antibiotic use.
The baseline analysis of 34 NHs showed wide variability in antibiotic use, with short-term NHs having significantly higher use. Penicillins were the most used antibiotic group while antibiotics used for urinary tract infections (UTIs) was the dominating indication group. Parenteral antibiotics accounted for 17% with a notable use of broad-spectrum agents.
The intervention, which targeted both physicians and nurses and included academic detailing, audit and feedback, clinical guiding tools and targeted education, did not significantly lower overall antibiotic use compared to controls. However, it achieved a substantial 33% reduction in antibiotics for UTIs and a 19% decrease in methenamine use.
Qualitative findings identified barriers and facilitators at multiple levels—organisational, clinical, resident, and next-of-kin, that influence prescribing behaviors. Increased professional knowledge and awareness, correct use of point-of-care tests and communication with next-of-kin were perceived as facilitators of prudent antibiotic use. The study confirmed the vital role of nurses in clinical decision-making, highlighting their integration into stewardship efforts.
The findings of the thesis underscore the need for tailored implementation strategies, improved interprofessional collaboration, good dialogue with next-of-kin and better diagnostic resources to optimise antibiotic use in NHs.
Additional information
Contact the research support staff.