Antimicrobial Therapy in Long-Term Care: Controversy, Colonization, and Criteria

To empower pharmacists to improve the outcomes of residents in long-term care facilities with urinary tract (UTIs) and skin and soft-tissue infections (SSTIs).

Relevant articles published since 1990 to date were found via PubMed regarding: long-term care, urinary tract infection, skin and soft-tissue infection, antimicrobials, multi-drug-resistant organisms, antimicrobial resistance, and dementia. Two additional Web sites were included for pharmacists' resources. A total of 28 sources were used (studies, Web sites, and review articles).

Sixteen studies were included regarding treatment of suspected infections, antimicrobial resistance of organisms present in long-term care facilities, and interventions previously attempted toward antimicrobial stewardship.

The types of infection seen in long-term care facilities were narrowed to UTIs and SSTIs. Data were extracted regarding the type/resistance of bacteria and treatment outcomes.

The review demonstrates growing antimicrobial resistance in long-term care for pathogens causing UTIs and SSTIs. The review outlines guidelines for the treatment of such infections, and the incidence of asymptomatic bacteriuria, and subsequent overtreatment. Also included is a discussion of antimicrobial usage in dementia and resources for antimicrobial stewardship.

Pharmacists can aid with antimicrobial stewardship in long-term care by educating providers on the need for changes in prescribing habits and the criteria for treating UTIs and SSTIs.