Antimicrobial stewardship program at a long-term care facility for severely disabled children and adults

The implementation of the antimicrobial stewardship program (ASP) has become a standard practice aimed at optimizing antimicrobial prescriptions to prevent further development of drug-resistant organisms. However, the challenges faced in long-term care facilities (LTCFs) often present a scarcity of human resources crucial for the effective implementation of ASP initiatives. Our study was to evaluate the impact of feasible ASP in the LTCF.

A quasi-experimental study was conducted at the Tokyo Metropolitan Fuchu Medical Center for the Disabled serving as a LTCF in Japan. The pre- and post-intervention periods were from April 2013 to March 2018 and from April 2018 to March 2019, respectively. Multidisciplinary ASP, including periodic educational interventions, utilization of internal treatment manuals, pre-authorization, and prospective audit and feedback on prescribing practices, was administered by the infectious diseases team from the Tokyo Metropolitan Children's Medical Center. We compared days of antimicrobial therapy (DOT) and resistance rates between the pre- and post-intervention phases.

Following the intervention, there was a noteworthy decline in the use of oral broad-spectrum antimicrobials (macrolides, fluoroquinolones, and third-generation cephalosporins), demonstrating a statistically significant level of change (p < 0.05). Throughout the study period, resistance rates of Escherichia coli and Pseudomonas aeruginosa to meropenem and levofloxacin remained largely stable, with no notable changes observed.

In this study, extending the expertise of antimicrobial stewardship from an adjoining acute-care facility to a LTCF was associated with a 42% reduction in the use of oral broad-spectrum antimicrobials.