Antimicrobial stewardship in long term care facilities: what is effective?

Abstract

Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection – limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection – were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.

Strategies and challenges of antimicrobial stewardship in long-term care facilities

“…Antimicrobial stewardship is therefore a pressing need in LTCFs and this has recently become a 'hot topic' [16][17][18][19]. Compared with the acute-care setting, antimicrobial stewardship programmes (ASPs) in LTCFs have tended to be less wellorganized and less resourced [20][21][22][23][24].…”

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities

“…18 Many of these interventions are labour intensive, and none have reported on cost-effectiveness or sustainability. 13 In a previous study, we reported that the use of prolonged antibiotic treatment in long-term care is more dependent on who prescribes the drug than the characteristics of the resident receiving the drug. 6 If decision-making about prescribing antibiotics is influenced by consistent and predictable historical patterns of practice -"prescriber tendencies" -then stewardship interventions focused on individual prescribers might offer an RESEARCH Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities exceeding 7 days and selection of fluoroquinolones.…”

“…12 Antibiotic stewardship interventions in long-term care have had promising but inconsistent effects on antibiotic use. [13][14][15] Prior initiatives have usually been multifaceted and have included educational sessions, [16][17][18][19][20][21] development of local guidelines, 16,17,[21][22][23] portable reference material, 16,19,23 on-site consultations about infectious diseases 24 or academic detailing. 18 Many of these interventions are labour intensive, and none have reported on cost-effectiveness or sustainability.…”

Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities

“…We estimated the frequency of inappropriate emtential associated poor health outcomes, resources are often pirical antibiotic prescribing in 3 Maryland SNFs and mealimited for diagnosis of infections and to guide empirical sured the effect of the antibiograms on antibiotic prescribing antibiotic therapy. 4,5 A recent review by Stone et al 6 updating in 1 of the SNFs. These data are essential to improve our understanding of the burden of inappropriate empirical antibiotic prescribing in SNFs and to identify opportunities to improve antibiotic prescribing in this setting.…”