Antibiotic Stewardship Programs Can Impact Health Outcomes for Nursing Home Residents
With multidrug-resistant organisms (MDROs) affecting as many as 1 in 3 residents, nursing homes are under growing pressure to prioritize antibiotic stewardship. However, according to an article in the February issue of JAMDA, there are still questions about what makes for the most successful antibiotic stewardship programs (ASPs) and what impact these programs have on outcomes.
The authors conducted a systematic review of current evidence regarding outcomes of ASPs in the nursing home setting. A total of 14 studies were included. The authors found that nursing home ASPs reduced the number of antibiotic prescriptions and improved compliance with recommended treatment guidelines. At the same time, prescribing reductions did not change the incidence of Clostridium difficile infection rates, hospitalizations, or mortality.
Nursing home residents pose unique challenges for antibiotic stewardship, the authors note, because multiple comorbidities combined with aging immune systems often lead to atypical and often subtle changes in the presentation of bacterial infection. The authors also observed that the high degree of hands-on care these residents often require contributes to the spread of MDROs from person to person. At the same time, the typical nursing home has limited resources for diagnostic testing, imaging and other interventions. All of these considerations present challenges for nursing home ASP implementation and effectiveness.
The evidence on the effectiveness of ASPs in nursing homes is encouraging but limited, the authors conclude. They stress that these programs can reduce antibiotic prescribing, which can potentially improve health outcomes for residents. However, they urge further study in this area.
The study was conducted by researchers at the Center for Aging and Health, the Department of Family Medicine, Department of Medicine, and Cecil G. Sheps Center for Health Services Research at the University of North Carolina, Chapel Hill.
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