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Antibiotic prescribing and antimicrobial stewardship in long-term care facilities: Past interventions and
Niyati Vyas1, Tyler Good2, Jorida Cila2
1Antimicrobial Resistance Task Force, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON.
Background:
The threat of antimicrobial resistance (AMR) is rising, leading to increased illness, death and healthcare costs. In long-term care facilities (LTCFs), high rates of infection coupled with high antibiotic use create a selective pressure for antimicrobial-resistant organisms that pose a risk to residents and staff as well as surrounding hospitals and communities. Antimicrobial stewardship (AMS) is paramount in the fight against AMR, but its adoption in LTCFs has been limited.
Methods:
This article summarizes factors influencing antibiotic prescribing decisions in LTCFs and the effectiveness of past AMS interventions that have been put in place in an attempt to support those decisions. The emphasis of this literature review is the Canadian LTCF landscape; however, due to the limited literature in this area, the scope was broadened to include international studies.
Results:
Prescribing decisions are influenced by the context of the individual patient, their caregivers, the clinical environment, the healthcare system and surrounding culture. Antimicrobial stewardship interventions were found to be successful in LTCFs, though there was considerable heterogeneity in the literature.
Conclusion:
This article highlights the need for more well-designed studies that explore innovative and multifaceted solutions to AMS in LTCFs.
Insights
Antimicrobial resistance (AMR) is a growing threat, especially in long-term care facilities (LTCFs). Antimicrobial stewardship (AMS) interventions show success in LTCFs, but more research is needed for effective implementation.
Area of Science:
- Healthcare Management
- Infectious Diseases
- Public Health
Background:
- Antimicrobial resistance (AMR) is a significant global health threat, increasing morbidity, mortality, and healthcare expenses.
- Long-term care facilities (LTCFs) are high-risk environments for AMR due to frequent infections and substantial antibiotic use, impacting residents, staff, and the wider community.
- Despite the critical role of antimicrobial stewardship (AMS) in combating AMR, its implementation in LTCFs remains limited.
Purpose of the Study:
- To review factors influencing antibiotic prescribing decisions within LTCFs.
- To evaluate the effectiveness of implemented AMS interventions in LTCFs.
- To explore the Canadian LTCF landscape while incorporating international studies due to limited Canadian data.
Main Methods:
- Literature review focusing on antibiotic prescribing and AMS interventions in LTCFs.
- Inclusion of Canadian and international studies to broaden the scope.
- Synthesis of findings on factors affecting prescribing and intervention outcomes.
Main Results:
- Antibiotic prescribing decisions are complex, influenced by patient, caregiver, clinical, systemic, and cultural factors.
- AMS interventions have demonstrated success in LTCFs, although results show significant variation.
- Heterogeneity in intervention effectiveness highlights the need for tailored approaches.
Conclusions:
- There is a clear need for more rigorously designed studies to develop innovative and comprehensive AMS strategies for LTCFs.
- Multifaceted solutions are required to effectively address the challenges of AMR in LTCFs.
- Further research should focus on optimizing AMS adoption and impact within these settings.
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