title: Antimicrobial Stewardship in Long-Term Care Facilities: A Call to Action.
abstract: Antimicrobial resistance is a global public health crisis and a national security threat to the United States, as stated in an executive order signed by the president in September 2014. This crisis is a result of indiscriminant antimicrobial use, which promotes selection for resistant organisms, increases the risk of adverse drug events, and renders patients vulnerable to drug-resistant infections. Antimicrobial stewardship is a key measure to combat antimicrobial resistance and specifically seeks to do this by improving antimicrobial use. Antimicrobial stewardship compliments infection control practices and it is important to note that these 2 disciplines are distinct and cannot be discussed interchangeably. Antimicrobial stewardship promotes the appropriate diagnosis, drug, dose, and duration of treatment. The appropriate diagnosis falls into the hands of the prescriber and clinical staff. Optimal antimicrobial drug selection, dosing strategy, and duration of treatment, however, often require expertise in antimicrobial therapy, such as an infectious disease-trained physician or pharmacist. Therefore, successful antimicrobial stewardship programs must be comprehensive and interdisciplinary. Most antimicrobial stewardship programs focus on hospitals; yet, in long-term care, up to 75% of antimicrobial use is inappropriate or unnecessary. Thus, one of the most pressing areas in need for antimicrobial stewardship is in long-term care facilities. Unfortunately, there is little evidence that describes effective antimicrobial stewardship interventions in this setting. This review discusses the need for and barriers to antimicrobial stewardship in long-term care facilities. Additionally, this review describes prior interventions that have been implemented and tested to improve antimicrobial use in long-term care facilities.
authors.affiliation: Center of Innovation for Long-term Services and Supports, Veterans Affairs Medical Center, Providence, RI; Infectious Diseases Research Program, Veterans Affairs Medical Center, Providence, RI; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI. Electronic address: haley.morrill@va.gov.
authors.forename: Haley J
authors.initials: HJ
authors.lastname: Morrill
authors.affiliation: Center of Innovation for Long-term Services and Supports, Veterans Affairs Medical Center, Providence, RI; Infectious Diseases Research Program, Veterans Affairs Medical Center, Providence, RI; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI.
authors.forename: Aisling R
authors.initials: AR
authors.lastname: Caffrey
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC) and Infectious Diseases Section, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Division of Infectious Disease and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH.
authors.forename: Robin L P
authors.initials: RL
authors.lastname: Jump
authors.affiliation: Center of Innovation for Long-term Services and Supports, Veterans Affairs Medical Center, Providence, RI; Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: David
authors.initials: D
authors.lastname: Dosa
authors.affiliation: Center of Innovation for Long-term Services and Supports, Veterans Affairs Medical Center, Providence, RI; Infectious Diseases Research Program, Veterans Affairs Medical Center, Providence, RI; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI; Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: LaPlante
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D006801:Humans; D057970:Inappropriate Prescribing; D009735:Nursing Homes
chemical_list: D000890:Anti-Infective Agents
keywords: Antimicrobial stewardship program; antibiotic use; antimicrobial resistance; long-term care; nursing home