EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
J Am Med Dir Assoc. 2012 Jul;13(6):568.e1-13. doi: 10.1016/j.jamda.2012.04.004. Epub 2012 May 9.
The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available on antibiotic use, antibiotic resistance, and strategies to reduce antibiotic resistance.
Relevant literature was identified by conducting a systematic search in the MEDLINE and EMBASE databases. Additional articles were identified by reviewing the reference lists of included articles, by searching Google Scholar, and by searching Web sites of relevant organizations.
A total of 156 articles were included in the review. Antibiotic use in long term care facilities is common; reported annual prevalence rates range from 47% to 79%. Part of the prescribed antibiotics is potentially inappropriate. The occurrence of antibiotic resistance is substantial in the long term care setting. Risk factors for the acquisition of resistant pathogens include prior antibiotic use, the presence of invasive devices, such as urinary catheters and feeding tubes, lower functional status, and a variety of other resident- and facility-related factors. Infection with antibiotic-resistant pathogens is associated with increased morbidity, mortality, and health care costs. Two general strategies to reduce antibiotic resistance in long term care facilities are the implementation of infection control measures and antibiotic stewardship.
The findings of this review call for the conduction of research and the development of policies directed at reducing antibiotic resistance and its subsequent burden for long term care facilities and their residents.
养老院和住宅护理设施中传染病的常见发生可能导致大量抗生素的使用，从而导致抗生素耐药性。本文以这些环境为重点，旨在提供有关抗生素使用、抗生素耐药性以及减少抗生素耐药性策略的相关文献的综合概述。
通过在 MEDLINE 和 EMBASE 数据库中进行系统检索，确定了相关文献。通过查阅纳入文献的参考文献列表、在 Google Scholar 上搜索以及在相关组织的网站上搜索，确定了其他相关文献。
共纳入 156 篇文章进行综述。长期护理机构中抗生素的使用很常见；报告的年发生率范围从 47%到 79%。部分处方抗生素可能不合适。长期护理环境中抗生素耐药性的发生率很高。获得耐药病原体的危险因素包括先前使用抗生素、存在侵入性装置（如导尿管和喂养管）、较低的功能状态以及各种其他与居民和设施相关的因素。抗生素耐药性病原体感染与发病率、死亡率和医疗保健成本增加有关。减少长期护理机构抗生素耐药性的两种一般策略是实施感染控制措施和抗生素管理。
本综述的研究结果呼吁开展研究和制定政策，以减少长期护理机构及其居民的抗生素耐药性及其后续负担。
