title: Antimicrobial stewardship in long-term care facilities in Belgium: a questionnaire-based survey of nursing homes to evaluate initiatives and future developments.
abstract: BACKGROUND
  The use of antimicrobials is intense and often inappropriate in long-term care facilities. Antimicrobial resistance has increased in acute and chronic care facilities, including those in Belgium. Evidence is lacking concerning antimicrobial stewardship programmes in chronic care settings. The medical coordinator practicing in Belgian nursing homes is a general practitioner designated to coordinate medical activity. He is likely to be the key position for effective implementation of such programmes. The aim of this study was to evaluate past, present, and future developments of antimicrobial stewardship programmes by surveying medical coordinators working in long-term care facilities in Belgium.
  
  
  METHODS
  We conducted an online questionnaire-based survey of 327 Belgian medical coordinators. The questionnaire was composed of 33 questions divided into four sections: characteristics of the respondents, organisational frameworks for implementation of the antimicrobial stewardship programme, tools to promote appropriate antimicrobial use and priorities of action. Questions were multiple choice, rating scale, or free text.
  
  
  RESULTS
  A total of 39 medical coordinators (12 %) completed the questionnaire. Past or present antimicrobial stewardship initiatives were reported by 23 % of respondents. The possibility of future developments was rated 2.7/5. The proposed key role of medical coordinators was rated <3/5 by 36 % of respondents. General practitioners, nursing staff, and hospital specialists are accepted as important roles. The use of antimicrobial guidelines was reported by only 19 % of respondents. Education was considered the cornerstone for any future developments. Specific diagnostic recommendations were considered useful, but chest x-rays were judged difficult to undertake. The top priority identified was to reduce unnecessary treatment of asymptomatic urinary infections.
  
  
  CONCLUSIONS
  Our study shows that the implementation of an antimicrobial stewardship programme is reported only in a minority of nursing homes. The possibility of future developments is uncertain. Nevertheless, the self-selected medical coordinators who responded to the survey reported a good knowledge of this complex problem. Despite a lack of optimism, medical coordinators seem to have the appropriate competencies to play a key role in antimicrobial stewardship in the future.
authors.affiliation: Department of Internal Medicine, Jolimont Hospital, Rue Ferrer 159, 7100 Haine-St-Paul, Belgium.
authors.forename: François
authors.initials: F
authors.lastname: Kidd
authors.affiliation: Observatoire Wallon de la Santé, Direction générale opérationnelle des Pouvoirs locaux, de l'Action sociale et de la Santé, Avenue Gouverneur Bovesse 100, 5100 Namur, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Dubourg
authors.affiliation: Consultant in the Department of Internal Medicine, Jolimont Hospital, Rue Ferrer 159, 7100 Haine-St-Paul, Belgium.
authors.forename: Francis
authors.initials: F
authors.lastname: Heller
authors.affiliation: Department of Infectious Diseases and General Internal Medicine, University Hospital of Liège, Avenue de L'Hòpital 1, 4000 Liège, Belgium.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Frippiat
keywords: Antibiotic prescribing; Antibiotic resistance; Antimicrobial stewardship; Belgium; Long-term care facilities; Nursing home