Antimicrobial resistance and stewardship in long-term care settings

Area of Science:

• Infectious Diseases
• Public Health
• Epidemiology

Background:

• Infections and antimicrobial resistance (AMR) in long-term care facilities (LTCFs) pose a significant public health challenge and future infectious disease threat.
• The increasing prevalence of AMR and inappropriate antimicrobial use in LTCFs highlights their role in community-wide resistance, exemplified by carbapenemase-producing Enterobacteriaceae spread.
• Implementing effective infection and surveillance control programs in LTCFs is difficult due to limited resources and fragmented medical care coordination.

Purpose of the Study:

• To review current epidemiological data on infections and AMR in LTCFs.
• To highlight the challenges and proven effectiveness of infection control interventions in LTCFs.
• To provide references to successful intervention programs for managing AMR in this setting.

Main Methods:

• Literature review of recent epidemiological information on AMR in LTCFs.
• Analysis of the impact of carbapenemase-producing Enterobacteriaceae spread on community AMR.
• Identification and summarization of effective infection control and surveillance programs.

Main Results:

• Interventions in LTCFs have demonstrated effectiveness in reducing inappropriate antibiotic use for asymptomatic bacteriuria.
• Improvements in hand hygiene compliance have been observed following targeted interventions.
• Effective strategies exist to halt the transmission of multidrug-resistant organisms within LTCFs.

Conclusions:

• LTCFs are critical in the broader AMR problem, necessitating focused infection control strategies.
• Despite resource limitations, interventions in LTCFs can significantly mitigate AMR.
• Evidence-based intervention programs are available and effective for controlling infections and AMR in LTCFs.