Antimicrobial Stewardship in Residential Aged Care Facilities

Need and Readiness Assessment

Ching Jou Lim; Megan Kwong; Rhonda L Stuart; Kirsty L Buising; N Deborah Friedman; Noleen Bennett; Allen C Cheng; Anton Y Peleg; Caroline Marshall; David CM Kong


BMC Infect Dis. 2014;14(410) 

In This Article


There is increasing evidence that the elderly population in residential aged care facilities (RACFs) serves as an important reservoir for multidrug-resistant (MDR) organisms,[1,2] with high antibiotic use causing selective pressure and encouraging the emergence of various MDR organisms.[3,4] As antibiotic resistance in bacteria increases and the development pipeline of new antibiotics declines, judicious use of antibiotics through antimicrobial stewardship (AMS) programs has become critical across all parts of the healthcare system, including the RACF setting. Formal AMS programs have been increasingly established in the acute-care hospital setting, but remain relatively uncommon in RACFs.[5]

Essentially, the need for AMS and the potential areas for AMS interventions are reliant upon existing antibiotic use and resistance patterns. For example, a study in Australian RACFs has shown less frequent use of broad-spectrum antibiotics such as fluoroquinolones[6] compared to long-term care facilities in the United States (US), where fluoroquinolone prescribing is widespread.[7,8] Likewise, the magnitude of antibiotic resistance has been reported to vary across RACFs in different geographical areas.[9] Not surprisingly, surveys involving Nebraska and Irish long-term care facilities have reported very distinctive AMS practices, presumably because AMS interventions are tailored according to the needs and resources of individual institutions in different geographical areas.[10,11]

International guidelines for infection control and prevention have strongly recommended initiation of AMS programs in the RACF setting;[12] however, practical models for AMS in this setting remain poorly delineated. Adopting hospital-based AMS programs in the RACF setting may be unrealistic due to differences in organizational resources and antibiotic prescribing patterns between these two healthcare settings. Recent studies from the US reported that AMS interventions involving multidisciplinary teams with regular audits are effective in reducing inappropriate antibiotic prescribing in the long-term care setting; however, these studies were mainly single centre and their sustainability remains in question.[13,14] To date, information about the feasibility, barriers and facilitators of AMS programs in RACFs has been scant. The perceived need and readiness for AMS interventions in the RACF setting can be explored via qualitative research that allows in-depth investigation into the social and environmental determinants of antibiotic prescribing practices;[15] however, such work had previously not been undertaken. In preparation for developing practical and sustainable AMS models in this setting, the current study explored the attitudes and perceptions of key healthcare providers towards AMS interventions in Australian RACFs.