Antimicrobial Stewardship in Long-Term Care Facilities: A Call to Action

Abstract

Antimicrobial resistance is a global public health crisis and a national security threat to the United States, as stated in an executive order signed by the president in September 2014. This crisis is a result of indiscriminant antimicrobial use, which promotes selection for resistant organisms, increases the risk of adverse drug events, and renders patients vulnerable to drug-resistant infections. Antimicrobial stewardship is a key measure to combat antimicrobial resistance and specifically seeks to do this by improving antimicrobial use. Antimicrobial stewardship compliments infection control practices and it is important to note that these 2 disciplines are distinct and cannot be discussed interchangeably. Antimicrobial stewardship promotes the appropriate diagnosis, drug, dose, and duration of treatment. The appropriate diagnosis falls into the hands of the prescriber and clinical staff. Optimal antimicrobial drug selection, dosing strategy, and duration of treatment, however, often require expertise in antimicrobial therapy, such as an infectious disease–trained physician or pharmacist. Therefore, successful antimicrobial stewardship programs must be comprehensive and interdisciplinary. Most antimicrobial stewardship programs focus on hospitals; yet, in long-term care, up to 75% of antimicrobial use is inappropriate or unnecessary. Thus, one of the most pressing areas in need for antimicrobial stewardship is in long-term care facilities. Unfortunately, there is little evidence that describes effective antimicrobial stewardship interventions in this setting. This review discusses the need for and barriers to antimicrobial stewardship in long-term care facilities. Additionally, this review describes prior interventions that have been implemented and tested to improve antimicrobial use in long-term care facilities.

Antibiotic Misuse in Hospital, Outpatient, and Long-Term Care Settings

“…Some reports suggest that up to 75% of antibiotic use in long-term care facilities is inappropriate [18]. The most commonly reported infections in nursing homes are UTIs, lower respiratory tract infections, skin and soft tissue infections, and gastroenteritis [19].…”

“…ASPs have demonstrated effectiveness in reducing inappropriate antibiotic use in nursing home settings [18]. However, we currently lack comprehensive studies looking into the different outcomes of ASP implementation in nursing homes, which can include antimicrobial utilization, health care utilization, costs, resistance, and clinical outcomes (eg, adverse events) [18].…”

“…However, we currently lack comprehensive studies looking into the different outcomes of ASP implementation in nursing homes, which can include antimicrobial utilization, health care utilization, costs, resistance, and clinical outcomes (eg, adverse events) [18]. Most nursing homes in the United States do not have a formal ASP.…”

“…When an infectious disease consult service was implemented at a 160-bed Veterans Affairs long-term care facility, a 30% reduction in total antimicrobial use was seen, along with a significant decline in positive C. difficile infection [18]. However, it is not practical for most nursing homes to establish this kind of program unless local hospitals share their resources with nursing homes.…”

NaCl: for the safer in vivo use of antibacterial silver based nanoparticles

“…1 However, with the misuse of antibiotics in clinics and animal husbandry, many bacteria have evolved in the past nearly 90 years, they are no longer sensitive to antibiotics and have caused bacterial resistance worldwide. [2][3][4][5] People will be forced to face a devastating reality, which is the post-antibiotics era, where most cures become futile.…”