Health Sciences Centre, University of Manitoba, Room GG443, 820 Sherbrook Street, Winnipeg R3A 1R9, Canada.
Antimicrob Resist Infect Control. 2014 Feb 12;3(1):6. doi: 10.1186/2047-2994-3-6.
Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection - limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection - were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.
长期护理机构中大量使用抗生素会促进抗微生物药物耐药菌的出现和持续存在，并导致不良后果，如艰难梭菌结肠炎。指南建议为这些机构制定抗生素管理计划，以促进最佳的抗生素使用。然而，这些计划的有效性或任何特定计划组成部分的贡献尚不清楚。在这项综述中，通过系统文献检索确定了描述长期护理机构抗生素管理计划评估的出版物。干预措施包括教育、制定指南、向从业人员提供反馈和传染病咨询。综述的研究在设施类型、使用的干预措施、实施和评估方面存在差异。针对所有感染的综合计划被报道至少在某些结果上改善了抗生素的使用。针对肺炎治疗的有针对性的计划效果甚微，而且仅对管理方面不确定的相关指标有效。针对尿路感染治疗的特定方面（限制无症状菌尿的治疗或预防尿路感染）的计划被报道是有效的。没有关于成本效益的报告，而且大多数计划的可持续性尚不清楚。需要进一步评估以确定长期护理机构有效的抗生素管理策略。
