Impact of a Multidisciplinary Intervention on Antibiotic Use for Nursing Home–Acquired Pneumonia

Linnebur, Sunny A.; Fish, Douglas N.; Ruscin, J. Mark; Radcliff, Tiffany A.; Oman, Kathy; Fink, Regina; Dorsten, Brent Van; Liebrecht, Debra; Fish, Ron; McNulty, Monica; Hutt, Evelyn

doi:10.1016/j.amjopharm.2011.09.009

Cited by 42 publications

(86 citation statements)

References 23 publications

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“…There were no changes in mortality or hospitalization for pneumonia in any of the study homes. In the second report describing pneumonia treatment, a nonrandomized trial compared eight intervention and eight control homes during a 2-year observation period [11]. This program included optimized practices for immunization and laboratory tests, interactive education sessions for staff, support to facilitate institutional change, and academic detailing for physicians.…”

Section: Resultsmentioning

confidence: 99%

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

Nicolle

2014

Antimicrob Resist Infect Control

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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.

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Section: Resultsmentioning

confidence: 99%

“…The studies restricted to pneumonia both reported no impact of comprehensive programs including education, guidelines and algorithms on overall antimicrobial use for this indication [10,11]. The successful outcomes were for changes in use of oral compared with parenteral therapy [10] or initiating antimicrobials within 4 hours [11].…”

Section: Discussionmentioning

confidence: 99%

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

Nicolle

2014

Antimicrob Resist Infect Control

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“…Only two studies, focusing on pneumonia, did not bring about an improvement in antibiotic prescribing [45,47], one possibly due to lack of power [47], and the other potentially because the academic detailing was performed by pharmacists [45]. Four out of 12 studies targeted only physicians [42,44,46] or nurses [43].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 97%

“…Table 2 summarizes all 12 published interventional studies that aimed to improve antibiotic use in LTCFs, of which all but one [43] had an educational component [29,32,[39][40][41][42][44][45][46][47][48].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 99%

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

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.

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“…[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. 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.…”

mentioning

confidence: 99%