Antimicrobial Stewardship in Long-Term Care Facilities
Summary
Antimicrobial stewardship in long-term care facilities (LTCFs) seeks to optimise the use of antibiotics to curb resistance, minimise adverse effects and ensure effective treatment for vulnerable residents. These settings, encompassing nursing homes, residential care and community-based assisted living, present distinctive challenges: frequent transitions to acute care, high prevalence of polymorbid and elderly populations, and widespread empirical prescribing, particularly for urinary and respiratory tract infections. Asymptomatic bacteriuria, non-specific symptoms such as confusion and reliance on routine urine cultures often lead to unwarranted antibiotic courses. Comprehensive stewardship frameworks blend diagnostic stewardship to reduce unnecessary testing, prospective audit and feedback to guide prescribers, educational outreach to nursing and medical staff, and collaborative engagement of pharmacists, microbiologists and infection preventionists. Monitoring antimicrobial consumption through point prevalence surveys and benchmarking between facilities fosters accountability and identifies targets for intervention. Globally, harmonised guidance encourages LTCFs to establish multidisciplinary stewardship teams, integrate treatment algorithms, and leverage telemedicine consultations. Such measures have demonstrated reductions in broad-spectrum antibiotic use, lowered rates of Clostridioides difficile infection and enhanced resident outcomes without compromising safety. The adoption of tailored stewardship initiatives in LTCFs represents a critical step in preserving antibiotic efficacy and safeguarding public health across the continuum of care.
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Antimicrobial Stewardship in Long-Term Care Facilities publication trend
The graph below shows the total number of articles in antimicrobial stewardship in long-term care facilities across all publications each year (not limited to Nature Index journals).
Technical terms
Antimicrobial stewardship: Organised efforts to optimise antimicrobial use, balancing effective treatment with minimised resistance and adverse outcomes.
Asymptomatic bacteriuria: Presence of bacteria in the urine without clinical symptoms, often leading to unnecessary antibiotic treatment in LTCFs.
Diagnostic stewardship: Strategies to ensure appropriate testing and interpretation of microbiological diagnostics to inform antibiotic decisions.
Prospective audit and feedback: A structured review of antimicrobial prescriptions with direct recommendations back to prescribers to improve decision-making.
Point prevalence survey: A cross-sectional assessment of antimicrobial use or infection rates at a single time point, used to benchmark and monitor stewardship efforts.
References
- Antibiotic prescribing for care-home residents: a population-based, cross-classified multilevel analysis in Scotland, UK. Age and Ageing (2025).
- Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. Eurosurveillance (2018).
- Implementation of an antimicrobial stewardship program targeting residents with urinary tract infections in three community long-term care facilities: a quasi-experimental study using time-series analysis. Antimicrobial Resistance & Infection Control (2015).
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