Antimicrobial Use in Long-Term–Care Facilities

Abstract

There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and the virtual absence of relevant clinical trials. This position paper recommends approaches to management of common infections in LTCF patients and proposes minimal standards for an antimicrobial review program. In developing these recommendations, the position paper acknowledges the unique aspects of provision of care in the LTCF.

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

“…1 Similar to the situation in acute care hospital settings, 2,3 it is estimated that about half of antibiotic use in long-term care facilities is unnecessary or inappropriate. 4 Consequently, there is great concern about adverse reactions and selection of antibiotic-resistant pathogens 5 in this setting. In addition, the development of new antimicrobial agents has slowed, 6 leaving clinicians with few options to treat antibioticresistant infections, which are associated with increases in length of stay, mortality, and cost.…”

Antibiotic Prescribing in 4 Assisted-Living Communities: Incidence and Potential for Improvement

“…This is at the lower end of the range identified by nursing home studies (25%-75%). 8 However, appropriateness is subjective and many minimum standards for prescribing antibiotics, such as those of Loeb et al, 26 are almost certainly too stringent. 27 Our data suggesting a trend toward prescribing reduction (Table 1) are encouraging, but a larger study (ie, powered to detect clinically meaningful changes) with an intervention that has more penetrance (especially among physicians) would be needed to identify whether and to what extent antibiotic prescribing can indeed be changed in AL.…”

“…However, in spite of Since antibiotic prescribing rates are high in nursing homes the large and growing population served by AL, this setting (ranging from 3 to 5 prescriptions per resident annually), 4 " 9 has received virtually no attention in attempts to either deconcern has been raised about potentially inappropriate prescribe or optimize antibiotic prescribing. 8 Studying this setscribing in these settings. 1 " A few studies of attempts to reduce ting would be important both because of the number of antibiotic overprescribing in nursing homes have been pubpersons served and because its organizational structure differs lished, and these have met with mixed results.…”

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

“…[4][5][6] As a result, vulnerable residents of these facilities are exposed to avoidable harms that range from allergy to organ-specific toxicities, 4,7 Clostridium difficile infection 8,9 and antimicrobial-resistant pathogens. 10,11 Many harms affect not only the direct recipients of these drugs but also neighbouring and future residents of the facility.…”