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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. In a review, Nicolle (2014) identified publications describing evaluation of antimicrobial stewardship programs for long-term care facilities 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.
Nicolle (2014) found that 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. Nicolle (2014) says there is a need for further evaluation to characterize effective antimicrobial stewardship for long-term care facilities. The research was published in Antimicrobial Resistance and Infection Control.Â Â
Reference: Nicolle LE. Antimicrobial stewardship in long term care facilities: what is effective? Antimicrobial Resistance and Infection Control 2014, 3:6Â doi:10.1186/2047-2994-3-6