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.
Keywords
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Article info
Publication history
Published online: January 05, 2016
Footnotes
H.J.M. and D.D. declare no conflicts of interest. A.R.C. and R.L.P.J. have received research funding from Pfizer Inc. K.L.L. has received research funding, or acted as an advisor or consultant for Merck, BARD/Davol, Forest, and Pfizer Inc.
The views expressed are those of the authors and do not necessarily reflect the position or policy of the United States Department of Veterans Affairs or the National Institutes of Health (NIH). This material is based on work supported, in part, by the Office of Research and Development, Department of Veterans Affairs. This work was also supported in part by funds from the Veterans Integrated Service Network (VISN) 1 Career Development Award (H.J.M.), the Providence VA Medical Center of Innovation in Long Term Services and Supports (COIN-LTSS; H.J.M., A.R.C., D.D.), the Geriatric Research Education and Clinical Centers (GRECC) in Veterans Integrated Service Network (VISN) 10 (R.L.P.J.) and from NIH, through the Clinical and Translational Science Collaborative of Cleveland (UL1TR000439) from the National Center for Advancing Translational Sciences component of the NIH and NIH Roadmap for Medical Research (R.L.P.J.).
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