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Table 1 Reports evaluating the implementation of comprehensive antimicrobial stewardship programs for long term care facilities (LTCF)

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

Reference, country Study design Interventions Outcomes
Schwartz et al., 2007 [6] US Prospective, before/after; single centre, hospital-based LTC wards; on-site ID consultation. 1. Four teaching sessions over 18 months including all 20 full time staff internists; groups of 3–7. Pre/post analysis of 100 random charts pre intervention and during 5 months after the last session:
2. Published guidelines on LTC infections and results of local audit discussed; interactive discussion of local cases. 1. Antimicrobial courses met guideline for diagnostic criteria: 32% vs 62%, p = 0.006
3. Evidence-based algorithms and guidelines developed with internists. 2. Initial antimicrobial therapy met guidelines: 11% vs 39%; p < 0.001
4. Pocket booklet with optimal management of LTC infection syndromes. 3. Antimicrobial days fell 29.7%, starts fell 25.9% - improvements sustained 2 yr post-intervention
Monette et al., 2007 [7] Canada Cluster, randomized controlled trial; 8 LTC, Montreal Interventions for experimental group: Experimental vs control homes at trial end:
1. Mailing antibiotic guide and individual prescribing profile past 3 months to 36 physicians. Antibiotic courses given by physician characterized as adherent or non-adherent. 1. Nonadherent prescriptions: 20.5% vs 5.1%
2. Likelihood of prescription of nonadherent antibiotics:
→post-intervention one: OR 0.47, (95% CI 0.21-1.0 1.05)
2. Repeat second mailing 4 months later.
→post-intervention two: OR 0.36 (0.18, 0.73)
→15 months follow-up: OR 0.48 (0.23-1.02)
Pettersson et al., 2011 [8] Sweden Cluster, randomized controlled trial; 58 NH 1. Local physician, nurse, developed guidelines in focus groups. Evaluation of guidelines in pilot study with revision. Effect of intervention (95% CI) at 2 years (differences):
Primary outcome:
Fluoroquinolones for UTI: 0.028 (−0.193, 0.249)
2. Small educational sessions – physicians, nurses.
Secondary outcomes:
UTIs/resident: 0.04 (−0.01, 0.09)
3. Feedback on prescribing & references to available guidelines; discussion of structural, organizational, social barriers to change. All infections:
antibiotics −0.12 (−0.23, -0.02)
“wait & see” 0.143 (0.047, 0.240)
Nitrofurantoin for lower UTI in women: - 0.077 (−0.247, 0.088)
Jump et al., 2012 [9] US Pre/post; single site with dedicated physician/nurse practitioner care on 4 LTCF wards. ID consultation service team (ID physician and nurse practitioner) once weekly on site and available by phone contact 24/7. 36 months pre compared with 18 months post: Reduction in
→total antibiotics, 30.1%, p < 0.001
→oral antibiotics, 31.6%, p,0.001
→intravenous antibiotics, 25%, p = 0.001
    Positive C. difficile/1,000 days decreased: time series, p = 0.04
  1. LTC: long term care facility; UTI: urinary tract infection.