Interventions to Improve Antimicrobial Stewardship for Older People in Care Homes: A Systematic Review

Nguyen, Hoa; Tunney, Michael; Hughes, Carmel

doi:10.1007/s40266-019-00637-0

Cited by 22 publications

(27 citation statements)

References 61 publications

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“…Nevertheless, it is very difficult to determine the original source of transmission in this population. The crucial role of care homes in the transmission of MDRO infections has been consistently reported [13][14][15][16]. A number of factors could explain this high transmission, e.g., healthcare personnel simultaneously working in several care homes, the high rate of hospitalization and antibiotic use in this vulnerable population, or a lack of resources and training in infection prevention measures, as previously suggested in Spain [17].…”

Section: Discussionmentioning

confidence: 75%

“…Although the daily probability of microbial transmission in nursing homes is significantly lower than in hospitals, the transmission of MDRO may be more effective given the increased length of stay of residents. A recent systematic review found a high frequency of AMDR in care homes [14]. In Spain, the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and a high rate of quinolone-resistant MRSA have been reported in community care homes [15].…”

Section: Introductionmentioning

confidence: 99%

“…In Spain, the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and a high rate of quinolone-resistant MRSA have been reported in community care homes [15]. Although the aforementioned review did not show conclusive results regarding the usefulness of strategies to reduce AMR in care homes [14], some evidence shows promising results. For instance, a recent antimicrobial stewardship intervention for older people in nursing homes conducted in North Carolina significantly reduced urine culture positive MDRO rates [16].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

et al. 2020

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Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

et al. 2020

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“…This does raise the issue of the most appropriate outcome to be used in a future, larger definitive trial. A systematic review 89 has extracted the range of outcomes that have been used in RCTs that have focused on antimicrobial stewardship in care homes for older people, which are shown in Table 32.…”

Section: Data Collection From Various Sourcesmentioning

confidence: 99%

A multifaceted intervention to reduce antimicrobial prescribing in care homes: a non-randomised feasibility study and process evaluation

Hughes

Ellard

Campbell

et al. 2020

Health Serv Deliv Res

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Background The most frequent acute health-care intervention that care home residents receive is the prescribing of medications. There are serious concerns about prescribing generally, and about antimicrobial prescribing in particular, with facilities such as care homes being described as an important ‘reservoir’ of antimicrobial resistance. Objectives To evaluate the feasibility and acceptability of a multifaceted intervention on the prescribing of antimicrobials for the treatment of infections. Design This was a non-randomised feasibility study, using a mixed-methods design with normalization process theory as the underpinning theoretical framework and consisting of a number of interlinked strands: (1) recruitment of care homes; (2) adaptation of a Canadian intervention (a decision-making algorithm and an associated training programme) for implementation in UK care homes through rapid reviews of the literature, focus groups/interviews with care home staff, family members of residents and general practitioners (GPs), a consensus group with health-care professionals and development of a training programme; (3) implementation of the intervention; (4) a process evaluation consisting of observations of practice and focus groups with staff post implementation; and (5) a survey of a sample of care homes to ascertain interest in a larger study. Setting Six care homes – three in Northern Ireland and three in the West Midlands. Participants Care home staff, GPs associated with the care homes and family members of residents. Interventions A training programme for care home staff in the use of the decision-making algorithm, and implementation of the decision-making algorithm over a 6-month period in the six participating care homes. REACH (REduce Antimicrobial prescribing in Care Homes) Champions were appointed in each care home to support intervention implementation and the training of staff. Main outcome measures The acceptability of the intervention in terms of recruitment, delivery of training, feasibility of data collection from a variety of sources, implementation, practicality of use and the feasibility of measuring the appropriateness of prescribing. Results Six care homes from two jurisdictions were recruited, and the intervention was adapted and implemented. The intervention appeared to be broadly acceptable and was implemented largely as intended, although staff were concerned about the workload associated with study documentation. It was feasible to collect data from community pharmacies and care homes, but hospitalisation data from administrative sources could not be obtained. The survey indicated that there was interest in participating in a larger study. Conclusions The adapted and implemented intervention was largely acceptable to care home staff. Approaches to minimising the data-collection burden on staff will be examined, together with access to a range of data sources, with a view to conducting a larger randomised study. Trial registration Current Controlled Trials ISRCTN10441831. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 8. See the NIHR Journals Library website for further project information. Queen’s University Belfast acted as sponsor.

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“…There are two Cochrane Systematic Reviews on interventions to improve antibiotic prescribing; one is in the ambulatory care setting [14] and the other is among hospital inpatients [15] . The ambulatory care review has not been updated since 2005 but more recent systematic reviews have been published about interventions in primary care, especially for respiratory diseases [13,16,17] and care homes [18] . They focused speci cally on primary care institutions and physicians, or systematic reviews of educational interventions.…”

Section: Introductionmentioning

confidence: 99%

Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: a systematic review of randomized controlled trials

Chang

Cui

Yang

et al. 2021

Preprint

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Background The global health system is improperly using antibiotics, particularly in the treatment of respiratory diseases. We aimed to examine the effectiveness of implementing a unifaceted and multifaceted intervention for unreasonable antibiotic prescriptions. Methods Relevant literature published in the databases of Pubmed, Embase, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Journal Full-text (CNKI) and Wanfang was searched. Data were independently filtered and extracted by two reviewers based on a pre-designed inclusion and exclusion criteria. The Cochrane collaborative bias risk tool was used to evaluate the quality of the included studies. Results A total of 1,074 relevant studies were obtained of which 69 were included in the systematic review. Fifty-nine studies reported positive results, that is, the primary results in the intervention groups were superior to those in the control groups. The remaining 10 studies had negative or partially negative results. In 22 studies the outcome variable was the antibiotic prescription rate with detailed reports of the number of prescriptions being further analyzed, of which 19 involved educational interventions for doctors, including: (1) Online training using email, web pages and webinar, (2) Antibiotic guidelines for information dissemination measures by email, postal or telephone reminder, (3) Training doctors in communication skills, (4) Short-term interactive educational seminars, and (5) Short-term field training sessions. Seventeen studies of interventions for health care workers also included: (6) Regular or irregular assessment/audit of antibiotic prescriptions, (7) Prescription recommendations from experts and peers delivered at a meeting or online, (8) Publicly reporting on doctors' antibiotic usage to patients, hospital administrators, and health authorities, (9) Monitoring/feedback prescribing behavior to general practices by email or poster, and (10) Studies involving patients and their families (n=10). Seventeen studies were rated as having a low risk of bias while five were rated as having a high risk of bias. Conclusion The combination of education, prescription audit, prescription recommendations from experts, public reporting, prescription feedback and patient or family member multifaceted interventions can effectively reduce antibiotic prescription rates in health care institutions. Moreover, adding multifaceted interventions to educational interventions can control antibiotic prescription rates and may be a more reasonable method. Registrations: This systematic review was registered in PROSPERO, registration number: CRD42020192560.

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Interventions to Improve Antimicrobial Stewardship for Older People in Care Homes: A Systematic Review

Abstract: Compliance with ethical standards As this was a systematic review, ethical approval to conduct the study was not required. Conflicts of interest Hoa Nguyen, Michael Tunney and Carmel Hughes have no conflicts of interest to declare.

Cited by 22 publications

References 61 publications

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

A multifaceted intervention to reduce antimicrobial prescribing in care homes: a non-randomised feasibility study and process evaluation

Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: a systematic review of randomized controlled trials

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