title: Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care.
abstract: BACKGROUND
  Antimicrobial stewardship may be important in long-term care facilities because of unnecessary or inappropriate antibiotic use observed in these residents, coupled with their increased vulnerability to health care-associated infections.
  
  
  OBJECTIVE
  To assess antibiotic use in a long-term care facility in order to identify potential antimicrobial stewardship needs.
  
  
  METHODS
  A retrospective descriptive study was conducted at the Veterans Centre, a long-term care facility at Sunnybrook Health Sciences Centre, Toronto, Ontario. All residents taking one or more antibiotics (n = 326) were included as participants. Antibiotic-use data for patients residing in the facility between April 1, 2011, and March 31, 2012, were collected and analyzed.
  
  
  RESULTS
  Totals of 358 patient encounters, 835 antibiotic prescriptions, and 193 positive culture results were documented during the study period. For 36% (302/835) of antibiotic prescriptions, the duration was more than 7 days. Cephalosporins (30%; 251/835) and fluoroquinolones (28%; 235/835) were the most frequently prescribed antibiotic classes. Urine was the most common source of samples for culture (60%; 116/193).
  
  
  CONCLUSIONS
  Characteristics of antimicrobial use at this long-term care facility that might benefit from further evaluation included potentially excessive use of fluoroquinolones and cephalosporins and potentially excessive duration of antibiotic use for individual patients.
authors.affiliation: BScPhm, was, at the time of this study, a pharmacy research student in the Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario. She is now with the Department of Pharmacy at West Park Healthcare Centre, Toronto, Ontario.
authors.forename: Lisa Dong-Ying
authors.initials: LD
authors.lastname: Wu
authors.affiliation: BSc, BScPhm, PharmD, FCSHP, is with the Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario. She has affiliate status with the Department of Medicine, Division of Infectious Diseases, and Division of Clinical Pharmacology, Sunnybrook Health Sciences Centre; the Sunnybrook Research Institute; and the Leslie L Dan Faculty of Pharmacy, University of Toronto.
authors.forename: Sandra A N
authors.initials: SA
authors.lastname: Walker
authors.affiliation: BScPhm, is with the Department of Pharmacy, Sunny-brook Health Sciences Centre, Toronto, Ontario.
authors.forename: Marion
authors.initials: M
authors.lastname: Elligsen
authors.affiliation: BSc, BScPhm, MSc, is with the Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario.
authors.forename: Lesley
authors.initials: L
authors.lastname: Palmay
authors.affiliation: MD, is with the Department of Microbiology and the Division of Infectious Diseases, Sunnybrook Health Sciences Centre; the Sunnybrook Research Institute; and the Faculty of Medicine, University of Toronto, Toronto, Ontario.
authors.forename: Andrew
authors.initials: A
authors.lastname: Simor
authors.affiliation: MD, MSc, is with the Division of Infectious Diseases, Sunnybrook Health Sciences Centre; the Sunnybrook Research Institute; the Faculty of Medicine, University of Toronto; and the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Nick
authors.initials: N
authors.lastname: Daneman
keywords: antibiotic use; antimicrobial stewardship; long-term care