ANTIMICROBIAL STEWARDSHIP IN LONG-TERM CARE FACILITIES BY BRIDGET OLSON, RPH, AND MICHAEL BUTERA, MD
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ntibiotic prescribing in long-term care facilities (LTCF) has long presented many challenges. The vulnerability of this cohabited patient population, with their multiple comorbidities and more invasive processes, has contributed to the increasing prevalence of multi-drug-resistant organisms, a higher incidence of Clostridiodes difficile (C.difficile) infections, and now, the burden of COVID-19 viral infections. Excessive exposure to antibacterials has come to the forefront of resistance concerns in recent years, with more attention now in the world of the current pandemic. California has again led the establishment of regulations through a series of Senate bills sponsored by Senator Jerry Hill, which require tracking of antibiotic-resistant infections and deaths, and a physician-supervised, multi-disciplinary Antimicrobial Stewardship Program (ASP) at all acute care hospitals (2014) and all LTCFs (2015). While the practice of Infection Prevention focuses on preventing infections and transmission between patients, Antimicrobial Stewardship offers a complimentary antibiotic expertise and coordination of various disciplines for goals of optimizing antibiotic use, improving 4
October 2020
safety associated with antibiotics, and decreasing the development of antibiotic resistance. Core elements of ASPs have been developed specifically for LTCFs by the CDC, while the California Department of Public Health has established more specific ASP guidelines and toolkits. Antimicrobial use can cause harm to patients through associated adverse events, including a major risk of associated C.difficile infection (CDI). The high rates of antibiotic use in LTCFs are driving increased rates of antibiotic resistance formation. More than 2.8 million infections, with >35,000 deaths occur each year in the U.S., as a direct result of antibiotic-resistant infections. Decades of overprescribing and misuse of antibiotics have resulted in bacteria that are increasingly resistant, creating a growing threat of new superbugs that are difficult or even impossible to treat. The most alarming has been the emergence of carbapenem-resistant Enterobacteriacae (CRE).