Antibiotic Stewardship Programs in Nursing Homes: A Systematic Review.

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Public Health

Background:

• Antibiotic stewardship programs (ASPs) are crucial for optimizing antibiotic use and combating antimicrobial resistance.
• Mandated in nursing homes (NHs), the impact of ASPs on resident outcomes remains under investigation.
• This systematic review assesses the evidence for ASP effectiveness in the NH setting.

Purpose of the Study:

• To systematically review the evidence on the outcomes of antibiotic stewardship programs implemented in nursing homes.
• To evaluate the impact of ASPs on resident health outcomes, healthcare utilization, and intermediate health metrics.

Main Methods:

• A comprehensive search of PubMed, CINAHL, EMBASE, and Cochrane Library was conducted.
• Included intervention trials of ASPs in NHs assessing mortality, Clostridium difficile infections, ED visits, hospital admissions, antibiotic prescriptions, and guideline adherence.
• 14 good or fair quality studies were included in the analysis.

Main Results:

• Eight studies reported a decrease in antibiotic prescriptions.
• Ten studies showed increased adherence to recommended guidelines.
• No statistically significant changes were observed in NH mortality, C. difficile infections, or hospitalizations.

Conclusions:

• Nursing home ASPs demonstrate effectiveness in improving intermediate outcomes like antibiotic prescribing patterns and guideline adherence.
• Current evidence does not support a significant impact of NH ASPs on major health outcomes or healthcare utilization.
• Further research with larger, longer-duration trials is necessary to ascertain the full impact of ASPs in nursing homes.