title: Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement.
abstract: The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their adoption has been slower in nursing homes. The antibiotic prescribing process in nursing homes is fundamentally different from that observed in hospital and clinic settings, with formidable challenges to implementation of effective antibiotic stewardship. Nevertheless, an emerging body of research points towards ways to improve antibiotic prescribing practices in nursing homes. This review summarizes the findings of this research and presents ways in which antibiotic stewardship can be implemented and optimized in the nursing home setting.
authors: School of Medicine and Public Health, University of Wisconsin, 1685 Highland Avenue, MFCB 5217, Madison, WI, 53705, USA. cjc@medicine.wisc.edu.|William S. Middleton Veterans Affairs Hospital, Madison, WI, USA. cjc@medicine.wisc.edu.
authors: Christopher J
authors: CJ
authors: Crnich
authors: Geriatric Research, Education and Clinical Center, Division of Internal Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.|Division of Infectious Disease, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors: Robin
authors: R
authors: Jump
authors: Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
authors: Barbara
authors: B
authors: Trautner
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: Philip D
authors: PD
authors: Sloane
authors: Division of Geriatric and Palliative Care Medicine, University of Michigan, Ann Arbor, MI, USA.|Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors: Lona
authors: L
authors: Mody
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*
chemical_list: D000900:Anti-Bacterial Agents