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Antimicrobial stewardship in long term care facilities: what is effective?

Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal...

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Autor principal: Nicolle, Lindsay E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931475/
https://www.ncbi.nlm.nih.gov/pubmed/24521205
http://dx.doi.org/10.1186/2047-2994-3-6
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author Nicolle, Lindsay E
author_facet Nicolle, Lindsay E
author_sort Nicolle, Lindsay E
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description Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection – limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection – were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.
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spelling pubmed-39314752014-02-22 Antimicrobial stewardship in long term care facilities: what is effective? Nicolle, Lindsay E Antimicrob Resist Infect Control Review Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection – limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection – were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities. BioMed Central 2014-02-12 /pmc/articles/PMC3931475/ /pubmed/24521205 http://dx.doi.org/10.1186/2047-2994-3-6 Text en Copyright © 2014 Nicolle; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Nicolle, Lindsay E
Antimicrobial stewardship in long term care facilities: what is effective?
title Antimicrobial stewardship in long term care facilities: what is effective?
title_full Antimicrobial stewardship in long term care facilities: what is effective?
title_fullStr Antimicrobial stewardship in long term care facilities: what is effective?
title_full_unstemmed Antimicrobial stewardship in long term care facilities: what is effective?
title_short Antimicrobial stewardship in long term care facilities: what is effective?
title_sort antimicrobial stewardship in long term care facilities: what is effective?
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931475/
https://www.ncbi.nlm.nih.gov/pubmed/24521205
http://dx.doi.org/10.1186/2047-2994-3-6
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